Healthcare Provider Details

I. General information

NPI: 1598183618
Provider Name (Legal Business Name): MARK RIGSBY MLS (ASCP)CM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2014
Last Update Date: 04/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 STUART ST
COLUMBIA SC
29207-5700
US

IV. Provider business mailing address

107 W WAVERLY PLACE CT
COLUMBIA SC
29229-7763
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-2260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: