1821437799 NPI number — FLORENCE GASTROENTEROLOGY, LLC

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 1821437799 NPI number — FLORENCE GASTROENTEROLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORENCE GASTROENTEROLOGY, LLC
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:
1821437799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29502-3239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-777-7122
Provider Business Mailing Address Fax Number:
843-777-7102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 E CHEVES ST
Provider Second Line Business Practice Location Address:
SUITE 430
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29506-2716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-777-7333
Provider Business Practice Location Address Fax Number:
843-777-7334
Provider Enumeration Date:
06/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SPURLING
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
843-777-7333

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30150572 . This is a "SELECT HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: C666 . This is a "MEDICARE PTAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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