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NPI Code Detail

MEDICARE: MEDICAL UNIVERSITY HOSPITAL AUTHORITY

MEDICARE: MEDICAL UNIVERSITY HOSPITAL AUTHORITY
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
13336C0002XClinic Pharmacy
23336C0003XCommunity/Retail Pharmacy
3333600000XPharmacy863SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22090196OTHERPK

General Provider Information

NPI Number : 1295840148
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Provider Business Mailing Address
First Line : 650 ELLIS OAK DR RM 119
Second Line :
City : CHARLESTON
State : SC
Zip : 29412-3089
Country : US
Telephone Number : 843-876-2969
Fax Number : 843-876-2967
Provider Business Practice Location Address
First Line : 650 ELLIS OAK DR RM 119
Second Line :
City : CHARLESTON
State : SC
Zip : 29412-3089
Country : US
Telephone Number : 843-876-2969
Fax Number : 843-876-2967
Authorized Official
Title or Position : COO
Name : THOMAS CRAWFORD
Credential :
Telephone Number : 843-792-8775
Provider Enumeration Date : 08/20/2006
Last Update Date : 08/24/2022

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1265000715 — MEGAN SCALLION MPH, MSW, LMSW
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1164124210 — DANIEL GLODENER MD
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Directions to “MEDICAL UNIVERSITY HOSPITAL AUTHORITY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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