=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740293422
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY OF SOUTH CAROLINA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 09/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 DEVINE ST
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29208-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-777-3175
-----------------------------------------------------
Fax | 866-245-2537
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 DEVINE ST
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29208-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-777-3175
-----------------------------------------------------
Fax | 866-245-2537
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF HEALTH OFFICER & ASSOC. VP
-----------------------------------------------------
Name | DR. STAY FRITZ
-----------------------------------------------------
Credential | PHD, PT
-----------------------------------------------------
Telephone | 803-777-3655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1000X
-----------------------------------------------------
Taxonomy Name | Student Health Clinic/Center
-----------------------------------------------------
License Number | 7492
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------