1780714907 NPI number — MEDICAL UNIVERSITY OF SOUTH CAROLINA

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 1780714907 NPI number — MEDICAL UNIVERSITY OF SOUTH CAROLINA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL UNIVERSITY OF SOUTH CAROLINA
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:
1780714907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
96 JONATHAN LUCAS ST
Provider Second Line Business Mailing Address:
CSB 816, P.O.BOX 250624
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29425-8900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-792-2529
Provider Business Mailing Address Fax Number:
843-792-4114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
96 JONATHAN LUCAS ST
Provider Second Line Business Practice Location Address:
CSB 816
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29425-8900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-792-2529
Provider Business Practice Location Address Fax Number:
843-792-4114
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ERBE
Authorized Official First Name:
LEE
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
843-792-3862

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  APN114 , 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)

  • Identifier: 2488 . This is a "BILLING NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com