Healthcare Provider Details

I. General information

NPI: 1851978225
Provider Name (Legal Business Name): FEDERAL BUREAU OF PRISONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GARY HILL ROAD
EDGEFIELD SC
29824
US

IV. Provider business mailing address

501 GARY HILL ROAD
EDGEFIELD SC
29824
US

V. Phone/Fax

Practice location:
  • Phone: 803-637-1500
  • Fax:
Mailing address:
  • Phone: 803-637-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ROSE MCNEAL
Title or Position: CHIEF PHARMACIST
Credential:
Phone: 803-637-1500