Basic Information
| Provider Information | |||||||||
| NPI: | 1407053853 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL UNIVERSITY OF SOUTH CAROLINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 167 ASHLEY AVENUE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437924316 | ||||||||
| FaxNumber: | 8437929314 | ||||||||
| Practice Location | |||||||||
| Address1: | 167 ASHLEY AVENUE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437924316 | ||||||||
| FaxNumber: | 8437929314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WYATT | ||||||||
| AuthorizedOfficialFirstName: | TEENA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENCY PROGRAM COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8437924316 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | LL28899 | SC | Y | Hospitals | General Acute Care Hospital |
No ID Information.