Healthcare Provider Details

I. General information

NPI: 1376152876
Provider Name (Legal Business Name): MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 W MEETING ST STE C
LANCASTER SC
29720-6220
US

IV. Provider business mailing address

PO BOX 603898
CHARLOTTE NC
28260-3898
US

V. Phone/Fax

Practice location:
  • Phone: 803-285-2700
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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