Healthcare Provider Details

I. General information

NPI: 1922424068
Provider Name (Legal Business Name): KIMECHE SHPRELL SPEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3928 ROSEWOOD DR
COLUMBIA SC
29205-3536
US

IV. Provider business mailing address

3928 ROSEWOOD DR
COLUMBIA SC
29205-3536
US

V. Phone/Fax

Practice location:
  • Phone: 803-782-7775
  • Fax:
Mailing address:
  • Phone: 803-782-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2013-46759-45790
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: