Healthcare Provider Details

I. General information

NPI: 1225586712
Provider Name (Legal Business Name): SILVERSAGE PHYSICIAN SERVICES OF SOUTH CAROLINA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 ELMS PLANTATION BLVD
NORTH CHARLESTON SC
29406-9164
US

IV. Provider business mailing address

PO BOX 23913
CHATTANOOGA TN
37422-3913
US

V. Phone/Fax

Practice location:
  • Phone: 843-764-3500
  • Fax:
Mailing address:
  • Phone: 423-815-1600
  • Fax: 423-763-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH L. SCOTT
Title or Position: PRESIDENT
Credential: D.O.
Phone: 423-815-1605