Basic Information
| Provider Information | |||||||||
| NPI: | 1245344902 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLESTON EMERGENCY SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10760 | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926850760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003963437 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2095 HENRY TECKLENBURG DRIVE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294145734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434021000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 03/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | RENK | ||||||||
| AuthorizedOfficialFirstName: | GEOFFREY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8434021000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | GP1954 | 05 | SC | MEDICAID |