Healthcare Provider Details

I. General information

NPI: 1649557752
Provider Name (Legal Business Name): MR. RICHARD ANTHONY IZBICKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9783 SC HIGHWAY 28 S
PARKSVILLE SC
29845-3436
US

IV. Provider business mailing address

9783 SOUTH SC HWY 28 POBOX4899
PARKSVILLE SC
29844-4899
US

V. Phone/Fax

Practice location:
  • Phone: 706-413-2866
  • Fax: 864-280-9966
Mailing address:
  • Phone: 706-413-2866
  • Fax: 864-280-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number090561672
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number090561672
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: