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NPI Code Detail

MEDICARE: ANDERSON DISTRICT 4

MEDICARE: ANDERSON DISTRICT 4
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
1103TS0200XSchool Psychologist3046SC

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 : 1508102328
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANDERSON DISTRICT 4
Provider Business Mailing Address
First Line : 315 E QUEEN ST
Second Line :
City : PENDLETON
State : SC
Zip : 29670-1721
Country : US
Telephone Number : 864-403-2000
Fax Number : 864-403-2099
Provider Business Practice Location Address
First Line : 315 E QUEEN ST
Second Line :
City : PENDLETON
State : SC
Zip : 29670-1721
Country : US
Telephone Number : 864-403-2000
Fax Number : 864-403-2099
Authorized Official
Title or Position : DIRECTOR OF SPECIAL EDUCATION
Name : MR. THOMAS WAYNE GOODWIN
Credential : LPES
Telephone Number : 864-403-2000
Provider Enumeration Date : 12/26/2012
Last Update Date : 12/26/2012

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Directions to “ANDERSON DISTRICT 4 ” Practice Location

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