Healthcare Provider Details

I. General information

NPI: 1366088460
Provider Name (Legal Business Name): PREFERRED HEALTH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2019
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SHOAL CREEK CIR
LEXINGTON SC
29072-7262
US

IV. Provider business mailing address

120 SHOAL CREEK CIR
LEXINGTON SC
29072-7262
US

V. Phone/Fax

Practice location:
  • Phone: 866-757-7333
  • Fax: 800-720-5171
Mailing address:
  • Phone: 866-757-7333
  • Fax: 800-720-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RUKUDZO D MAZAIWANA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 866-757-7333