1528058641 NPI number — KERSHAW HEALTH

Table of content: (NPI 1528058641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528058641 NPI number — KERSHAW HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERSHAW HEALTH
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:
6
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:
1528058641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1315 ROBERTS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29020-3737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-432-4311
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 PINNACLE PARKWAY
Provider Second Line Business Practice Location Address:
BUILDING 100 SUITE 208
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29045-8999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-424-5165
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WEEKS
Authorized Official First Name:
DONNIE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
803-713-6227

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP2222 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com