Healthcare Provider Details

I. General information

NPI: 1366499048
Provider Name (Legal Business Name): DOCTORS CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 HENDERSON ST
COLUMBIA SC
29201-2619
US

IV. Provider business mailing address

PO BOX 63418
CHARLOTTE NC
28263-3418
US

V. Phone/Fax

Practice location:
  • Phone: 803-758-2602
  • Fax: 803-253-8896
Mailing address:
  • Phone: 803-758-2602
  • Fax: 803-253-8896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHELLEY JANSSEN
Title or Position: CHIEF MEDICAL OFFICER
Credential: M. D.
Phone: 803-782-4278