=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952336521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CASC AQUISITION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 PEPPER HILL WAY
-----------------------------------------------------
City | AIKEN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29801-2818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-642-6060
-----------------------------------------------------
Fax | 803-642-0754
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 PEPPER HILL WAY
-----------------------------------------------------
City | AIKEN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29801-2818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-642-6060
-----------------------------------------------------
Fax | 803-642-0754
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF NURSING
-----------------------------------------------------
Name | MRS. ASHLEY H. WHEELER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 803-642-6060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | ASF-082
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------