Healthcare Provider Details

I. General information

NPI: 1164476735
Provider Name (Legal Business Name): PSC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 B ROBERTSON BLVD
WALTERBORO SC
29488-5713
US

IV. Provider business mailing address

415 B ROBERTSON BLVD
WALTERBORO SC
29488-5713
US

V. Phone/Fax

Practice location:
  • Phone: 843-542-9530
  • Fax: 843-542-9532
Mailing address:
  • Phone: 843-542-9530
  • Fax: 843-542-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number22695
License Number StateSC

VIII. Authorized Official

Name: PETER S CARNOHAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 843-542-9530