MEDICARE: AUDREY ELLERBE BOYKIN

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	343900000X	Non-emergency Medical Transport (VAN)
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1538812433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY ELLERBE BOYKIN

Provider Business Mailing Address
First Line	:	2101 ETTERS LN, CASSATT, SC, 29032, USA
Second Line	:
City	:	CASSATT
State	:	SC
Zip	:	29032-0101
Country	:	US
Telephone Number	:	803-729-5071
Fax Number	:	803-424-8300

Provider Business Practice Location Address
First Line	:	910B BROAD ST
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29020-4315
Country	:	US
Telephone Number	:	803-729-5071
Fax Number	:	803-424-8300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	02/03/2023

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