Healthcare Provider Details

I. General information

NPI: 1255186631
Provider Name (Legal Business Name): TRUE VINE HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1773 VILLAGE PARK DR
ORANGEBURG SC
29118-2475
US

IV. Provider business mailing address

1773 VILLAGE PARK DR
ORANGEBURG SC
29118-2475
US

V. Phone/Fax

Practice location:
  • Phone: 803-535-3600
  • Fax:
Mailing address:
  • Phone: 803-535-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: KATRINA JAMISON
Title or Position: COO
Credential: PHARMD
Phone: 803-535-3600