Healthcare Provider Details

I. General information

NPI: 1487991501
Provider Name (Legal Business Name): ANDERSON DISTRICT 4
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 RIVERSIDE ST
PENDLETON SC
29670-1211
US

IV. Provider business mailing address

458 RIVERSIDE ST
PENDLETON SC
29670-1211
US

V. Phone/Fax

Practice location:
  • Phone: 864-403-2200
  • Fax: 864-646-8025
Mailing address:
  • Phone: 864-403-2200
  • Fax: 864-646-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number68523
License Number StateSC

VIII. Authorized Official

Name: MRS. HEIDI B MCCAULLEY
Title or Position: REGISTERED NURSE
Credential: RN BSN
Phone: 864-403-2200