Healthcare Provider Details

I. General information

NPI: 1700882388
Provider Name (Legal Business Name): ALLERGY ASTHMA SINUS CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CHEVES ST STE 420
FLORENCE SC
29506-2649
US

IV. Provider business mailing address

800 E CHEVES ST STE 420
FLORENCE SC
29506-2649
US

V. Phone/Fax

Practice location:
  • Phone: 843-679-9335
  • Fax: 843-679-9294
Mailing address:
  • Phone: 843-679-9335
  • Fax: 843-679-9294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number15976
License Number StateSC

VIII. Authorized Official

Name: DR. JOSEPH G MOYER
Title or Position: PRESIDENT
Credential: MD
Phone: 843-679-9335