Healthcare Provider Details

I. General information

NPI: 1013822477
Provider Name (Legal Business Name): DANIEL ISLAND EMERGENCY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 BEECH HILL ROAD
SUMMERSVILLE SC
29485
US

IV. Provider business mailing address

PO BOX 43008
BELFAST ME
04915-1282
US

V. Phone/Fax

Practice location:
  • Phone: 854-287-6500
  • Fax:
Mailing address:
  • Phone: 770-874-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM H LARSEN
Title or Position: EVP, CREDENTIALING
Credential:
Phone: 770-874-5400