1750609889 NPI number — KERSHAWHEALTH

Table of content: (NPI 1750609889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750609889 NPI number — KERSHAWHEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERSHAWHEALTH
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:
1750609889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 WINDSOR CV
Provider Second Line Business Mailing Address:
SUITE 402
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29223-1833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-788-5916
Provider Business Mailing Address Fax Number:
803-788-9564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1165 HIGHWAY 1 S
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
LUGOFF
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29078-8966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-438-3800
Provider Business Practice Location Address Fax Number:
803-438-3898
Provider Enumeration Date:
05/13/2010

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: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 369382 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 400480 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 328735 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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