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NPI Code Detail

MEDICARE: PRN HEALTHCARE STAFFING, LC

MEDICARE: PRN HEALTHCARE STAFFING, LC
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
1347C00000XPrivate Vehicle
2251E00000XHome Health Agency
3251S00000XCommunity/Behavioral Health Agency
4261QC1500XCommunity Health Clinic/Center
5302F00000XExclusive Provider Organization
6305S00000XPoint of Service
7335V00000XPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
8291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1184195158
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRN HEALTHCARE STAFFING, LC
Provider Business Mailing Address
First Line : 4325 DICK POND RD STE B
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29588-6810
Country : US
Telephone Number : 843-353-4651
Fax Number : 866-446-4652
Provider Business Practice Location Address
First Line : 4325 DICK POND RD STE B
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29588-6810
Country : US
Telephone Number : 843-353-4651
Fax Number : 866-446-4652
Authorized Official
Title or Position : PHLEBOTOMIST
Name : MRS. LATONYA D SANDERS-MILLER
Credential : RPT, CMA, NOTARY
Telephone Number : 843-957-8782
Provider Enumeration Date : 12/17/2018
Last Update Date : 01/18/2022

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