MEDICARE: TINA L. PERRY

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
1	311ZA0620X	Adult Care Home Facility	IHCP-1870	SC
2	343900000X	Non-emergency Medical Transport (VAN)	IHCP-1870	SC
3	347C00000X	Private Vehicle	IHCP-1870	SC
4	372500000X	Chore Provider	IHCP-1870	SC
5	3747A0650X	Attendant Care Provider	IHCP-1870	SC
6	374U00000X	Home Health Aide	IHCP-1870	SC
7	376J00000X	Homemaker	IHCP-1870	SC
8	253Z00000X	In Home Supportive Care Agency	IHCP-1870	SC

General Provider Information

NPI Number	:	1073218418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA L. PERRY

Provider Business Mailing Address
First Line	:	97 SUMMIT RIDGE CIR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7148
Country	:	US
Telephone Number	:	803-556-1992
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 GERVAIS ST STE 204
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3415
Country	:	US
Telephone Number	:	803-401-5137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	04/04/2023

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Directions to “ TINA L. PERRY ” Practice Location

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