=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124065057
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANMED HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2006
-----------------------------------------------------
Last Update Date | 05/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 ROBERTS BLVD
-----------------------------------------------------
City | WILLIAMSTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29697-1136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-847-7323
-----------------------------------------------------
Fax | 864-847-7543
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 100174
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29202-3174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-512-5800
-----------------------------------------------------
Fax | 864-512-5292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | STEPHEN JAN GRIGSBY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-512-1109
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------