Healthcare Provider Details

I. General information

NPI: 1639590359
Provider Name (Legal Business Name): USC TELEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 ASHTON POINTE BLVD
BEAUFORT SC
29906-6024
US

IV. Provider business mailing address

818 ASHTON POINTE BLVD
BEAUFORT SC
29906-6024
US

V. Phone/Fax

Practice location:
  • Phone: 850-843-3239
  • Fax: 850-770-1084
Mailing address:
  • Phone: 850-843-3239
  • Fax: 850-770-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number10143
License Number StateSC

VIII. Authorized Official

Name: NICOLE PERATA
Title or Position: MSW INTERN
Credential:
Phone: 850-843-3239