Healthcare Provider Details

I. General information

NPI: 1831186360
Provider Name (Legal Business Name): DARRELL KEVIN TEGTMEYER MPAS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 11/05/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10160 DORCHESTER ROAD
SUMMERVILLE SC
29485-8527
US

IV. Provider business mailing address

613 BART BELLAMY LN
COTTAGEVILLE SC
29435-3034
US

V. Phone/Fax

Practice location:
  • Phone: 843-871-7900
  • Fax:
Mailing address:
  • Phone: 843-321-5927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2822
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: