Healthcare Provider Details

I. General information

NPI: 1982352415
Provider Name (Legal Business Name): BLUFFTON JASPER VOLUNTEERS IN MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 PLANTATION PARK DR BLDG 600
BLUFFTON SC
29910-9001
US

IV. Provider business mailing address

PO BOX 2653
BLUFFTON SC
29910-2653
US

V. Phone/Fax

Practice location:
  • Phone: 843-706-7080
  • Fax:
Mailing address:
  • Phone: 843-706-7090
  • Fax: 843-706-7078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN CASEY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 843-706-7090