Healthcare Provider Details

I. General information

NPI: 1942669981
Provider Name (Legal Business Name): OUTZ MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 HIGHWAY 153
PIEDMONT SC
29673-9498
US

IV. Provider business mailing address

PO BOX 447
EASLEY SC
29641-0447
US

V. Phone/Fax

Practice location:
  • Phone: 864-220-0103
  • Fax: 864-220-9925
Mailing address:
  • Phone: 864-986-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number23843
License Number StateSC

VIII. Authorized Official

Name: CHARLES OUTZ JR.
Title or Position: OWNER
Credential: MD
Phone: 864-986-5665