1528561453 NPI number — SEA ISLAND MEDICAL CARE

Table of content: (NPI 1528561453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528561453 NPI number — SEA ISLAND MEDICAL CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEA ISLAND MEDICAL CARE
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:
1528561453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2114 HIGHWAY 41 STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29466-6204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-388-9000
Provider Business Mailing Address Fax Number:
843-388-6937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2114 HIGHWAY 41
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-388-9000
Provider Business Practice Location Address Fax Number:
843-388-6937
Provider Enumeration Date:
03/16/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RHODES
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
843-252-1150

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1326141938 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1982116331 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1164427811 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1932437662 . This is a "NPI" identifier . This identifiers is of the category "OTHER".