Healthcare Provider Details

I. General information

NPI: 1265999197
Provider Name (Legal Business Name): MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 FREEDOM BLVD STE 300
FLORENCE SC
29505-6074
US

IV. Provider business mailing address

PO BOX 936801
CHARLOTTE NC
31193-6801
US

V. Phone/Fax

Practice location:
  • Phone: 843-674-2854
  • Fax:
Mailing address:
  • Phone: 843-792-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARYN RAE
Title or Position: DIRECTOR
Credential:
Phone: 843-876-1344