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General NPI Number Information
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NPI Number | 1952051963
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Entity Type | Organization
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Legal Business Name | IN HIS SERVICE PRIMARY CARE LLC
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 136 FORUM DRIVE STE 4 #555
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City | COLUMBIA
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State | SC
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Zip | 29229
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Country | US
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Telephone | 803-638-8628
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Fax | 833-672-3092
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Provider Business Mailing Address
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Address Line | 136 FORUM DRIVE STE 4 #555
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City | COLUMBIA
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State | SC
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Zip | 29229
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Country | US
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Telephone | 803-638-8628
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Fax | 833-672-3092
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Authorized Official
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Title or Position | PROVIDER
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Name | MEGAN ALEXANDRIA WOLFF
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Credential | DNP, APRN, FNP-BC
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Telephone | 803-638-8628
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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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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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