Healthcare Provider Details

I. General information

NPI: 1558721969
Provider Name (Legal Business Name): ESSENTIAL HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6575 PURRYSBURG RD
HARDEEVILLE SC
29927-4524
US

IV. Provider business mailing address

6575 PURRYSBURG RD
HARDEEVILLE SC
29927-4524
US

V. Phone/Fax

Practice location:
  • Phone: 843-247-3054
  • Fax:
Mailing address:
  • Phone: 843-247-3054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1846
License Number StateSC

VIII. Authorized Official

Name: DR. BLAIR MARTIN
Title or Position: PRESIDENT
Credential: DC
Phone: 843-247-3054