Healthcare Provider Details

I. General information

NPI: 1275591687
Provider Name (Legal Business Name): BECKIE MERRITT CHURCH N. P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MEDICAL PARK RD SUITE 300
COLUMBIA SC
29203-6864
US

IV. Provider business mailing address

8 MEDICAL PARK RD P O BOX 8446
COLUMBIA SC
29203-6864
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-6511
  • Fax: 803-744-4731
Mailing address:
  • Phone: 803-256-6511
  • Fax: 803-744-4731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number42510
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: