Healthcare Provider Details

I. General information

NPI: 1245849546
Provider Name (Legal Business Name): JENNIFER J DOMBEK HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER J SHORT

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 BELLS HWY
WALTERBORO SC
29488-2703
US

IV. Provider business mailing address

668 BELLS HWY
WALTERBORO SC
29488-2706
US

V. Phone/Fax

Practice location:
  • Phone: 843-782-3866
  • Fax: 843-782-3866
Mailing address:
  • Phone: 843-782-3866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License NumberHT-1011
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHT-1011
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: