1598215899 NPI number — SYLVIA BUNDOTICH APRN

Table of content: SYLVIA BUNDOTICH APRN (NPI 1598215899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598215899 NPI number — SYLVIA BUNDOTICH APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUNDOTICH
Provider First Name:
SYLVIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

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:
1598215899
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1053 CENTER STREET
Provider Second Line Business Mailing Address:
SC HOUSE CALLS INC
Provider Business Mailing Address City Name:
WEST COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-491-0909
Provider Business Mailing Address Fax Number:
855-632-8329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1109 MEDICAL CENTER DRIVE, SUITE A2
Provider Second Line Business Practice Location Address:
SC HOUSE CALLS INC
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-491-0909
Provider Business Practice Location Address Fax Number:
855-632-8329
Provider Enumeration Date:
10/11/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  3010531 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN285818 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100477710 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13909647 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".