Healthcare Provider Details

I. General information

NPI: 1609214378
Provider Name (Legal Business Name): POSEIDON INPATIENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 MEDICAL PLAZA DR
CHARLESTON SC
29406-9104
US

IV. Provider business mailing address

18167 US HIGHWAY 19 N SUITE 650
CLEARWATER FL
33764-3528
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-7000
  • Fax:
Mailing address:
  • Phone: 800-507-8874
  • Fax: 727-536-2896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GREGORY J. BYRNE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-712-2000