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General NPI Number Information
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NPI Number | 1851717623
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Entity Type | Organization
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Legal Business Name | PHYSICIAN AT HOME, PC
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 300 SINGLETON RIDGE RD
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City | CONWAY
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State | SC
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Zip | 29526-9142
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Country | US
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Telephone | 413-563-7534
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Fax |
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Provider Business Mailing Address
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Address Line | 820 67TH AVE N P.O. BOX 70157
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City | MYRTLE BEACH
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State | SC
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Zip | 29572-0200
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Country | US
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Telephone | 413-563-7534
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH A. SANTIAGO
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Credential | M.D.
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Telephone | 413-563-7534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 34596
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License Number State | SC
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