Healthcare Provider Details

I. General information

NPI: 1346902475
Provider Name (Legal Business Name): SOUTH CAROLINA ELITE PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 01/20/2023
Certification Date: 10/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CAUGHMAN FARM LN STE 630
LEXINGTON SC
29072-7342
US

IV. Provider business mailing address

201 CAUGHMAN FARM LN
LEXINGTON SC
29072-7342
US

V. Phone/Fax

Practice location:
  • Phone: 803-771-1993
  • Fax:
Mailing address:
  • Phone: 803-771-1993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER COOPER
Title or Position: OWNER
Credential: MD
Phone: 803-629-1900