Healthcare Provider Details

I. General information

NPI: 1578982351
Provider Name (Legal Business Name): GRETCHEN ANN HSU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 03/07/2023
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HEALTHY WAY STE 1200
ANDERSON SC
29621-7916
US

IV. Provider business mailing address

PO BOX 100174
COLUMBIA SC
29202-3174
US

V. Phone/Fax

Practice location:
  • Phone: 864-716-6140
  • Fax: 864-716-6149
Mailing address:
  • Phone: 864-716-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101020973
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number83384
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: