1417954587 NPI number — CITY OF GOOSE CREEK

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417954587 NPI number — CITY OF GOOSE CREEK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF GOOSE CREEK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417954587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1768
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOOSE CREEK
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29445-1768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-797-6220
Provider Business Mailing Address Fax Number:
843-572-0155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
519 N GOOSE CREEK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOOSE CREEK
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29445-2962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-797-6220
Provider Business Practice Location Address Fax Number:
843-863-5208
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HOWANYK
Authorized Official First Name:
TYLER
Authorized Official Middle Name:
D
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
843-797-6220

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  18201 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 502897 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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