Healthcare Provider Details

I. General information

NPI: 1295998763
Provider Name (Legal Business Name): CAROLINA OCCUPATIONAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2008
Last Update Date: 07/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 BLANDING ST
COLUMBIA SC
29201-3441
US

IV. Provider business mailing address

1715 BLANDING ST
COLUMBIA SC
29201-3441
US

V. Phone/Fax

Practice location:
  • Phone: 803-799-3926
  • Fax: 803-256-7896
Mailing address:
  • Phone: 803-799-3926
  • Fax: 803-256-7896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10320
License Number StateSC

VIII. Authorized Official

Name: MITCHELL HENRY HEGQUIST
Title or Position: OWNER
Credential: MD
Phone: 803-799-3926