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General NPI Number Information
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NPI Number | 1235459900
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Entity Type | Organization
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Legal Business Name | OPH MEDICAL, LLC
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Dates
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Enumeration Date | 06/04/2010
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Last Update Date | 06/04/2010
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Provider Practice Location Address
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Address Line | 61 SHORELINE DR
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City | COLUMBIA
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State | SC
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Zip | 29229-7300
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Country | US
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Telephone | 803-665-6170
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Fax | 803-788-5823
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Provider Business Mailing Address
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Address Line | 4611 HARD SCRABBLE RD SUITE 207
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City | COLUMBIA
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State | SC
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Zip | 29229-8584
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Country | US
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Telephone | 803-665-6170
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Fax | 803-788-5823
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Authorized Official
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Title or Position | CEO
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Name | DR. OLIVER PIERRE HARDEN
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Credential | M.D.
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Telephone | 803-665-6170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 019338
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License Number State | SC
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