Healthcare Provider Details

I. General information

NPI: 1063169035
Provider Name (Legal Business Name): HUNTER WELCH PSS, SAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 COLONIAL DR
COLUMBIA SC
29203-6818
US

IV. Provider business mailing address

PO BOX 50597
COLUMBIA SC
29250-0597
US

V. Phone/Fax

Practice location:
  • Phone: 803-726-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberCPSS-2098
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: