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NPI Code Detail

MEDICARE: TRUESDALE MEDICAL CENTER LLC

MEDICARE: TRUESDALE MEDICAL CENTER LLC
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
1207RI0200XInfectious Disease Physician18613SC
2207Q00000XFamily Medicine Physician18613SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336627371
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRUESDALE MEDICAL CENTER LLC
Provider Business Mailing Address
First Line : 5064 RIVERS AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-6304
Country : US
Telephone Number : 843-266-3870
Fax Number : 843-225-7541
Provider Business Practice Location Address
First Line : 5064 RIVERS AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-6304
Country : US
Telephone Number : 843-266-3870
Fax Number : 843-225-7541
Authorized Official
Title or Position : CEO
Name : MR. BRADLEY D. CHILDS
Credential :
Telephone Number : 843-747-2273
Provider Enumeration Date : 08/01/2018
Last Update Date : 09/19/2023

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Directions to “TRUESDALE MEDICAL CENTER LLC ” Practice Location

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