Basic Information
| Provider Information | |||||||||
| NPI: | 1891748828 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIM | ||||||||
| FirstName: | ROWENA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 C HILLCREST DR | ||||||||
| Address2: | PALMETTO HEALTH ALLIANCE | ||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296401221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648551644 | ||||||||
| FaxNumber: | 8648556101 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 C HILLCREST DR | ||||||||
| Address2: | PALMETTO HEALTH ALLIANCE | ||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296401221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648551644 | ||||||||
| FaxNumber: | 8648556101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 14552 | SC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 145523 | 05 | SC | MEDICAID |