Healthcare Provider Details

I. General information

NPI: 1326167537
Provider Name (Legal Business Name): THOMSON STUDENT HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THOMSON STUDENT HEALTH CTR USC
COLUMBIA SC
29208-0001
US

IV. Provider business mailing address

1409 DEVINE STREET THOMSON STUDENT HEALTH CENTER
COLUMBIA SC
29208
US

V. Phone/Fax

Practice location:
  • Phone: 803-777-2358
  • Fax:
Mailing address:
  • Phone: 803-777-3957
  • Fax: 803-777-9063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number36498
License Number StateSC

VIII. Authorized Official

Name: DR. DEBORAH BECK
Title or Position: EXECUTIVE DIRECTOR
Credential: ED.D
Phone: 803-777-3957