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General NPI Number Information
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NPI Number | 1184704850
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Entity Type | Organization
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Legal Business Name | PARKSIDE MEDICAL CONSULTANTS LLC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 410 UNIVERSITY PKWY SUITE 2300
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City | AIKEN
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State | SC
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Zip | 29801-6807
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Country | US
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Telephone | 803-649-6366
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Fax | 803-649-6347
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Provider Business Mailing Address
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Address Line | PO BOX 2037
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City | AIKEN
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State | SC
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Zip | 29802
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Country | US
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Telephone | 803-649-6366
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Fax | 803-649-6347
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARGO JOHANNA MUNIZ
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Credential | MD RPH
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Telephone | 803-649-6366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 22170
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License Number State | SC
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