1497040802 NPI number — UNIVERSITY OF SOUTH CAROLINA SCHOOL OF MEDICINE

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 1497040802 NPI number — UNIVERSITY OF SOUTH CAROLINA SCHOOL OF MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF SOUTH CAROLINA SCHOOL OF MEDICINE
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:
1497040802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6439 GARNERS FERRY RD
Provider Second Line Business Mailing Address:
BLDG 1, B33
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29209-1638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-216-3406
Provider Business Mailing Address Fax Number:
803-216-3413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6439 GARNERS FERRY RD
Provider Second Line Business Practice Location Address:
BLDG 1, B33
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29209-1638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-216-3406
Provider Business Practice Location Address Fax Number:
803-216-3413
Provider Enumeration Date:
06/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NAGARKATTI
Authorized Official First Name:
MITZI
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIR OF PATH, MICRO, AND IMMUNO
Authorized Official Telephone Number:
803-216-3404

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  G28417 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZCS92995755 . This is a "STATE HEALTH PLAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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