Healthcare Provider Details

I. General information

NPI: 1588950570
Provider Name (Legal Business Name): THE MEDICAL UNIVERSITY OF SOUTH CAROLINA FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COURTENAY DR
CHARLESTON SC
29425-8911
US

IV. Provider business mailing address

41 SMITH ST APT A
CHARLESTON SC
29401-1847
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-5556
  • Fax:
Mailing address:
  • Phone: 843-814-3721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number33921
License Number StateSC

VIII. Authorized Official

Name: CHISTOPHER HANNEGAN
Title or Position: FELLOWSHIP PROGRAM DIRECTOR
Credential: M.D
Phone: 843-876-5556