Healthcare Provider Details

I. General information

NPI: 1689753519
Provider Name (Legal Business Name): MUSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVE
CHARLESTON SC
29425-0001
US

IV. Provider business mailing address

7094 WINDMILL CREEK RD
CHARLESTON SC
29414-7574
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberLL28072
License Number StateSC

VIII. Authorized Official

Name: JODI ALLEN
Title or Position: PROGRAM COORDINATOR
Credential:
Phone: 843-792-2731