Basic Information
| Provider Information | |||||||||
| NPI: | 1083120729 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARCIS HEALTHCARE, LLC | ||||||||
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| OtherOrganizationName: | SIGNE SPINE & REHAB, LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 93 SPRINGVIEW LN UNIT B | ||||||||
| Address2: | |||||||||
| City: | SUMMERVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294858143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432664883 | ||||||||
| FaxNumber: | 8437935444 | ||||||||
| Practice Location | |||||||||
| Address1: | 929 BOWMAN RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294643237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437304124 | ||||||||
| FaxNumber: | 8438064295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2017 | ||||||||
| LastUpdateDate: | 12/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | DRIGGERS | ||||||||
| AuthorizedOfficialFirstName: | DEBBE | ||||||||
| AuthorizedOfficialMiddleName: | DAME | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 8432664883 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | SC | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 208VP0014X | SC | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 363A00000X | SC | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | SC | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 208100000X | SC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | GP6337 | 05 | SC | MEDICAID |