1619022662 NPI number — S.F. WORSHAM MD PA

Table of content: (NPI 1619022662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619022662 NPI number — S.F. WORSHAM MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S.F. WORSHAM MD PA
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:
S.F. WORSHAM MD PA FAMILY PRACTICE
Provider Other Organization Name Type Code:
3
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:
1619022662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 BUFORD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDERSON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-224-1316
Provider Business Mailing Address Fax Number:
864-224-5068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 BUFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-224-1316
Provider Business Practice Location Address Fax Number:
864-224-5068
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WORSHAM
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
FORD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
864-224-1316

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  16215 , 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)





Copyright © 2007-2024 www.npivalidator.com