Basic Information
| Provider Information | |||||||||
| NPI: | 1295715977 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUGH D. DURRENCE, MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 418 FOLLY RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294122625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437955362 | ||||||||
| FaxNumber: | 8437951921 | ||||||||
| Practice Location | |||||||||
| Address1: | 418 FOLLY RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294122625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437955362 | ||||||||
| FaxNumber: | 8437951921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | DURRENCE | ||||||||
| AuthorizedOfficialFirstName: | HUGH | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 8437955362 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | R.PH., MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 18668 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 186685 | 05 | SC | MEDICAID | 260887564 | 01 | SC | CHAMPUS | OTHER | 080149463 | 01 | SC | MEDICARE RAILROAD | OTHER |