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General NPI Number Information
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NPI Number | 1821294992
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Entity Type | Organization
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Legal Business Name | JOHN HINDERSMAN
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2750 LAUREL ST STE 102
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City | COLUMBIA
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State | SC
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Zip | 29204-2023
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Country | US
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Telephone | 803-799-0585
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Fax |
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Provider Business Mailing Address
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Address Line | 2750 LAUREL ST STE 102
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City | COLUMBIA
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State | SC
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Zip | 29204-2023
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Country | US
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Telephone | 803-799-0585
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JOHN HINDERSMAN
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Credential | M.D.
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Telephone | 803-799-0585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 007387
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License Number State | SC
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