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
1	283XC2000X	Children's Rehabilitation Hospital

General Provider Information

NPI Number	:	1659101277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL UNIVERSITY HOSPITAL AUTHORITY

Provider Business Mailing Address
First Line	:	PO BOX 23319
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-3319
Country	:	US
Telephone Number	:	843-792-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 MCCLENNAN BANKS
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-1164
Country	:	US
Telephone Number	:	843-792-1414
Fax Number	:

Authorized Official
Title or Position	:	CHIEF, PAYOR RELATIONS
Name	:	KARYN RAE
Credential	:
Telephone Number	:	843-876-1344

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	02/07/2025

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