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NPI Code Detail

MEDICARE: BARRETT C SHILO PA

MEDICARE: BARRETT C SHILO PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantMA000162LPA

General Provider Information

NPI Number : 1053376988
Entity Type Code : Individual
Provider Name (Legal Business Name) : BARRETT C SHILO PA
Provider Business Mailing Address
First Line : 2001 LAUREL ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-1018
Country : US
Telephone Number : 803-254-3278
Fax Number : 803-255-2715
Provider Business Practice Location Address
First Line : 2001 LAUREL ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-1018
Country : US
Telephone Number : 803-254-3278
Fax Number : 803-255-2715
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2006
Last Update Date : 07/08/2007

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Directions to “ BARRETT C SHILO PA” Practice Location

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