MEDICARE: INVISTA

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	163WX0106X	Occupational Health Registered Nurse	35976	SC

General Provider Information

NPI Number	:	1649702531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INVISTA

Provider Business Mailing Address
First Line	:	643 HIGHWAY 1 S
Second Line	:
City	:	LUGOFF
State	:	SC
Zip	:	29078-9174
Country	:	US
Telephone Number	:	803-425-3363
Fax Number	:	803-425-2742

Provider Business Practice Location Address
First Line	:	643 HIGHWAY 1 S
Second Line	:
City	:	LUGOFF
State	:	SC
Zip	:	29078-9174
Country	:	US
Telephone Number	:	803-425-3363
Fax Number	:	803-425-2742

Authorized Official
Title or Position	:	OCCUPATIONAL HEALTH NURSE
Name	:	MRS. DIANE K FREEMAN
Credential	:	RN
Telephone Number	:	803-425-3363

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	03/30/2017

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Practice Location Address:

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1720735939 — ASIA FELDER MA, NCC, LPC, ADC
Practice Location Address:

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1861499618 — ROBERT KABAKJIAN SR. P.A.-C
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Directions to “INVISTA ” Practice Location

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