Healthcare Provider Details

I. General information

NPI: 1336627371
Provider Name (Legal Business Name): TRUESDALE MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5064 RIVERS AVE
NORTH CHARLESTON SC
29406-6304
US

IV. Provider business mailing address

5064 RIVERS AVE
NORTH CHARLESTON SC
29406-6304
US

V. Phone/Fax

Practice location:
  • Phone: 843-266-3870
  • Fax: 843-225-7541
Mailing address:
  • Phone: 843-266-3870
  • Fax: 843-225-7541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18613
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number18613
License Number StateSC

VIII. Authorized Official

Name: MR. BRADLEY D. CHILDS
Title or Position: CEO
Credential:
Phone: 843-747-2273