Healthcare Provider Details

I. General information

NPI: 1578181467
Provider Name (Legal Business Name): AMERICAN THYROID INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N GOULD ST STE R
SHERIDAN WY
82801-6317
US

IV. Provider business mailing address

1477 KINLOCH LN
MOUNT PLEASANT SC
29464-4860
US

V. Phone/Fax

Practice location:
  • Phone: 307-217-6410
  • Fax:
Mailing address:
  • Phone: 804-690-8103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY HARRIS HENDERSON
Title or Position: OWNER
Credential: MD
Phone: 804-690-8103