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General NPI Number Information
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NPI Number | 1104259340
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Entity Type | Organization
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Legal Business Name | SOUTH CAROLINA DEPARTMENT OF CORRECTIONS
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 4444 BROAD RIVER RD
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City | COLUMBIA
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State | SC
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Zip | 29210-4012
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Country | US
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Telephone | 803-896-2707
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Fax |
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Provider Business Mailing Address
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Address Line | 4444 BROAD RIVER RD P. O. BOX 21787
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City | COLUMBIA
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State | SC
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Zip | 29210-4012
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Country | US
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Telephone | 803-896-2707
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOHN BRANHAM TOMARCHIO
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Credential | M.D.
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Telephone | 803-896-1233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 33514
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License Number State | SC
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