Healthcare Provider Details

I. General information

NPI: 1790086502
Provider Name (Legal Business Name): RONALD EDWARD SHUFORD R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 CARTER ST
COLUMBIA SC
29204-2811
US

IV. Provider business mailing address

1109 SALUDA CHASE WAY
WEST COLUMBIA SC
29169-6042
US

V. Phone/Fax

Practice location:
  • Phone: 803-786-1183
  • Fax:
Mailing address:
  • Phone: 803-210-8144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0066305
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number0066305
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: