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NPI Code Detail

MEDICARE: AUGUSTINE HEALTH GROUP, LLC

MEDICARE: AUGUSTINE HEALTH GROUP, 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
1207RC0000XCardiovascular Disease Physician

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 : 1740484658
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUGUSTINE HEALTH GROUP, LLC
Provider Business Mailing Address
First Line : PO BOX 60496
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0496
Country : US
Telephone Number : 803-256-5460
Fax Number :
Provider Business Practice Location Address
First Line : 120 GATEWAY CORPORATE BLVD
Second Line :
City : COLUMBIA
State : SC
Zip : 29203-9611
Country : US
Telephone Number : 803-256-5460
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : MR. JEREMY W WHITAKER
Credential : CPC
Telephone Number : 803-865-4798
Provider Enumeration Date : 06/13/2007
Last Update Date : 04/29/2008

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Directions to “AUGUSTINE HEALTH GROUP, LLC ” Practice Location

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