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General NPI Number Information
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NPI Number | 1457159071
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Entity Type | Organization
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Legal Business Name | AGA SC CLINICAL, LLC
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 1010 MEDICAL CENTER DR STE 100
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City | HARDEEVILLE
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State | SC
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Zip | 29927-3452
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Country | US
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Telephone | 706-548-0008
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Fax | 706-369-9673
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Provider Business Mailing Address
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Address Line | 1010 MEDICAL CENTER DR STE 100
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City | HARDEEVILLE
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State | SC
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Zip | 29927-3452
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Country | US
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Telephone | 706-548-0008
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Fax | 706-369-9673
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Authorized Official
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Title or Position | SENIOR MANAGER OF PAYER ENROLLMENT
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Name | KIMBERLY RUSCH
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Credential |
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Telephone | 706-701-0193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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