Healthcare Provider Details

I. General information

NPI: 1942245246
Provider Name (Legal Business Name): COLLETON MEDICAL HOSPITALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ROBERTSON BLVD
WALTERBORO SC
29488-2787
US

IV. Provider business mailing address

501 ROBERTSON BLVD
WALTERBORO SC
29488-2787
US

V. Phone/Fax

Practice location:
  • Phone: 843-782-2000
  • Fax: 843-549-6254
Mailing address:
  • Phone: 843-782-2000
  • Fax: 843-549-6254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. H H THOMPSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 843-782-2720