Healthcare Provider Details

I. General information

NPI: 1568524478
Provider Name (Legal Business Name): CORNELL EDWARD RUFF R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COLONIAL DR
COLUMBIA SC
29203-6827
US

IV. Provider business mailing address

PO BOX 4042
COLUMBIA SC
29240-4042
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-1555
  • Fax:
Mailing address:
  • Phone: 803-247-6114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number58456
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: