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General NPI Number Information
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NPI Number | 1255009163
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Entity Type | Organization
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Legal Business Name | ELM PEDIATRICS, LLC
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 800 W MAIN ST
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City | LAKE CITY
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State | SC
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Zip | 29560-4400
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Country | US
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Telephone | 843-977-7337
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Fax | 843-956-5415
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Provider Business Mailing Address
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Address Line | 800 W MAIN ST
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City | LAKE CITY
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State | SC
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Zip | 29560-4400
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Country | US
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Telephone | 843-977-7337
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Fax | 843-956-5415
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. HEATHER BROWN
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Credential | RN
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Telephone | 843-977-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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