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NPI Code Detail

MEDICARE: KATE S EDEN PA

MEDICARE: KATE S EDEN PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant1389SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225142300
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATE S EDEN PA
Provider Business Mailing Address
First Line : PO BOX 751649
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1649
Country : US
Telephone Number : 843-789-1620
Fax Number : 843-724-2440
Provider Business Practice Location Address
First Line : 2093 HENRY TECKLENBURG DR STE 200E
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-5742
Country : US
Telephone Number : 843-958-2500
Fax Number : 843-958-2680
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 12/23/2021

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Directions to “ KATE S EDEN PA” Practice Location

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