Healthcare Provider Details

I. General information

NPI: 1003970898
Provider Name (Legal Business Name): MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVE
CHARLESTON SC
29403-5836
US

IV. Provider business mailing address

PO BOX 250819
CHARLESTON SC
29425-0819
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberHTL811
License Number StateSC

VIII. Authorized Official

Name: SONYA FLOYD
Title or Position: DIRECTOR
Credential:
Phone: 843-876-1344