Healthcare Provider Details

I. General information

NPI: 1619517133
Provider Name (Legal Business Name): EHEALTH MEDICAL SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MAIN ST
CLIO SC
29525-3001
US

IV. Provider business mailing address

1526 EBENEZER RD
DARLINGTON SC
29532-7603
US

V. Phone/Fax

Practice location:
  • Phone: 843-306-6105
  • Fax: 843-306-6515
Mailing address:
  • Phone: 843-639-7484
  • Fax: 843-306-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE ADAMS
Title or Position: CEO/PRESIDENT
Credential:
Phone: 843-306-6105