1972521243 NPI number — MR. PHILLIP MERRIDA HAMPTON CRNA

Table of content: MR. PHILLIP MERRIDA HAMPTON CRNA (NPI 1972521243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972521243 NPI number — MR. PHILLIP MERRIDA HAMPTON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMPTON
Provider First Name:
PHILLIP
Provider Middle Name:
MERRIDA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1972521243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1321 LADY STREET 1ST FLOOR
Provider Second Line Business Mailing Address:
PALMETTO HEALTH
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-296-2548
Provider Business Mailing Address Fax Number:
803-296-2525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 HARDEN ST EXT 5 MEDICAL PARK
Provider Second Line Business Practice Location Address:
PALMETTO HEALTH RICHLAND
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-296-2548
Provider Business Practice Location Address Fax Number:
803-296-2525
Provider Enumeration Date:
07/17/2006

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: 367500000X , with the licence number:  2916 , 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)





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