Healthcare Provider Details

I. General information

NPI: 1053142315
Provider Name (Legal Business Name): EMPOWERME MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 ASHLEY RIVER RD
CHARLESTON SC
29414-4752
US

IV. Provider business mailing address

1335 STRASSNER DR
BRENTWOOD MO
63144-1872
US

V. Phone/Fax

Practice location:
  • Phone: 877-367-9772
  • Fax:
Mailing address:
  • Phone: 877-367-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID CHURCH
Title or Position: VP FINANCE
Credential:
Phone: 618-972-5228