Basic Information
Provider Information
NPI: 1821738089
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KANIA
FirstName: RICK
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 109 PHYSICIANS DR
Address2:  
City: GREER
State: SC
PostalCode: 296502446
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 109 PHYSICIANS DR
Address2:  
City: GREER
State: SC
PostalCode: 296502446
CountryCode: US
TelephoneNumber: 8647979150
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/29/2022
LastUpdateDate: 07/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XLL87841SCY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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