=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255378964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARLESTON HEMATOLOGY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2006
-----------------------------------------------------
Last Update Date | 03/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 DOUGHTY ST #280
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-577-6957
-----------------------------------------------------
Fax | 843-577-6523
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 DOUGHTY ST #280
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-577-6957
-----------------------------------------------------
Fax | 843-577-6523
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MR. JOHN DAX ARRINGTON
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 843-577-6957
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------