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General NPI Number Information
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NPI Number | 1700749488
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE MEDICAL LLC
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 2260 VISTA RD
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City | FORT MILL
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State | SC
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Zip | 29708
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Country | US
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Telephone | 803-556-5341
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Fax | 803-784-7994
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Provider Business Mailing Address
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Address Line | 6650 RIVERS AVE STE 100
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-4809
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Country | US
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Telephone | 803-556-5341
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Fax | 803-784-7994
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Authorized Official
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Title or Position | OWNER/SOLE MEMBER
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Name | HSIAO SORIANO
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Credential | MD
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Telephone | 803-556-5341
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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 |
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License Number State |
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