Basic Information
| Provider Information | |||||||||
| NPI: | 1992897466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALSUP | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AAS, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 STUART ST | ||||||||
| Address2: | MONCRIEF ARMY COMMUNITY HOSPITAL ATTN: MCXL-PQ | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292075700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037512618 | ||||||||
| FaxNumber: | 8037512689 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 STUART ST | ||||||||
| Address2: | MONCRIEF ARMY COMMUNITY HOSPITAL ATTN: MCXL-PQ | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292075700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037512618 | ||||||||
| FaxNumber: | 8037512689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WX0106X | R41,128 | SC | Y | Nursing Service Providers | Registered Nurse | Occupational Health |
No ID Information.