Healthcare Provider Details

I. General information

NPI: 1083003941
Provider Name (Legal Business Name): MSN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WELLNESS BLVD SUITE 111
IRMO SC
29063-2871
US

IV. Provider business mailing address

1 WELLNESS BLVD SUITE 111
IRMO SC
29063-2871
US

V. Phone/Fax

Practice location:
  • Phone: 803-917-1684
  • Fax:
Mailing address:
  • Phone: 615-620-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORETTA RICARD NOLES
Title or Position: PARTNER
Credential:
Phone: 803-917-1684