Healthcare Provider Details

I. General information

NPI: 1083831770
Provider Name (Legal Business Name): VI-CARE GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 FOREST DR SUITE B
COLUMBIA SC
29206-4934
US

IV. Provider business mailing address

PO BOX 5721
COLUMBIA SC
29250-5721
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-2273
  • Fax: 803-799-0854
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: F KIRK PETERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 803-779-2273