Healthcare Provider Details

I. General information

NPI: 1578954426
Provider Name (Legal Business Name): HEALTHWORKS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240C CENTRAL AVE
SUMMERVILLE SC
29483-3148
US

IV. Provider business mailing address

1240C CENTRAL AVE
SUMMERVILLE SC
29483-3148
US

V. Phone/Fax

Practice location:
  • Phone: 843-821-8787
  • Fax: 843-821-8799
Mailing address:
  • Phone: 843-821-8787
  • Fax: 843-821-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY P KRAICHELY
Title or Position: PRESIDENT
Credential: D.C.
Phone: 843-821-8787