Healthcare Provider Details

I. General information

NPI: 1497039390
Provider Name (Legal Business Name): MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7771 PALMETTO COMMERCE PKWY RM 404
CHARLESTON SC
29420-8825
US

IV. Provider business mailing address

150 ASHLEY AVE ROOM 618
CHARLESTON SC
29425-8907
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-2866
  • Fax: 843-985-9854
Mailing address:
  • Phone: 843-792-5691
  • Fax: 843-792-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number13497
License Number StateSC

VIII. Authorized Official

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