Healthcare Provider Details

I. General information

NPI: 1295387249
Provider Name (Legal Business Name): PENNY B BROACH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 01/10/2024
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SC HOUSE CALLS INC. 111 DOCTORS CIR.
COLUMBIA SC
29203
US

IV. Provider business mailing address

SC HOUSE CALLS INC. 111 DOCTORS CIR.
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 800-491-0909
  • Fax: 864-640-4400
Mailing address:
  • Phone: 800-491-0909
  • Fax: 864-640-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23033
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: