Healthcare Provider Details

I. General information

NPI: 1013226745
Provider Name (Legal Business Name): JCRK MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HOSPITAL DR STE 120
MT PLEASANT SC
29464-3261
US

IV. Provider business mailing address

1300 HOSPITAL DR STE 120
MT PLEASANT SC
29464-3261
US

V. Phone/Fax

Practice location:
  • Phone: 843-388-0660
  • Fax: 843-849-8419
Mailing address:
  • Phone: 843-388-0660
  • Fax: 843-849-8419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateSC

VIII. Authorized Official

Name: DR. JAMES E CRAIGIE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 843-388-0660