MEDICARE: MOUNT PLEASANT NEPHROLOGY 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
1	207RN0300X	Nephrology Physician	23565	SC

General Provider Information

NPI Number	:	1437588423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT PLEASANT NEPHROLOGY LLC

Provider Business Mailing Address
First Line	:	900 BOWMAN RD
Second Line	:	SUITE 101
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3203
Country	:	US
Telephone Number	:	843-637-0525
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 BOWMAN RD
Second Line	:	SUITE A-1
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3203
Country	:	US
Telephone Number	:	843-637-0525
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	MICHELLE M SHEPARD
Credential	:	MD
Telephone Number	:	843-637-0525

Provider Enumeration Date	:	11/11/2013
Last Update Date	:	04/10/2014

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