Healthcare Provider Details

I. General information

NPI: 1659470433
Provider Name (Legal Business Name): MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 RUTLEDGE ST SUITE 106
CHARLESTON SC
29425-8903
US

IV. Provider business mailing address

150 ASHLEY AVENUE, 6TH FLOOR MSC 584
CHARLESTON SC
29425
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-0253
  • Fax:
Mailing address:
  • Phone: 843-792-5691
  • Fax: 843-792-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number4404
License Number StateSC

VIII. Authorized Official

Name: THOMAS CRAWFORD
Title or Position: COO
Credential:
Phone: 843-792-8775