MEDICARE: MEDICAL UNIVERSITY HOSPITAL AUTHORITY

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1417684192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL UNIVERSITY HOSPITAL AUTHORITY

Provider Business Mailing Address
First Line	:	PO BOX 23467
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-3467
Country	:	US
Telephone Number	:	843-792-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 CHESTER AVE
Second Line	:
City	:	GREAT FALLS
State	:	SC
Zip	:	29055-1104
Country	:	US
Telephone Number	:	843-792-1414
Fax Number	:

Authorized Official
Title or Position	:	CHIEF PAYOR RELATIONS AND REIMBURSE
Name	:	KARYN RAE
Credential	:
Telephone Number	:	843-876-1344

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	12/02/2024

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Directions to “MEDICAL UNIVERSITY HOSPITAL AUTHORITY ” Practice Location

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