MEDICARE: MEDICAL UNIVERSITY HOSPITAL AUTHORITY

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	9750	SC
3	3336C0004X	Compounding Pharmacy
4	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2119087	OTHER		PK

General Provider Information

NPI Number	:	1821238551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL UNIVERSITY HOSPITAL AUTHORITY

Provider Business Mailing Address
First Line	:	150 ASHLEY AVE
Second Line	:	MSC 584
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8907
Country	:	US
Telephone Number	:	843-792-1009
Fax Number	:	843-792-0566

Provider Business Practice Location Address
First Line	:	25 COURTENAY DR
Second Line	:	RM M104
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8911
Country	:	US
Telephone Number	:	843-876-0199
Fax Number	:	843-876-4583

Authorized Official
Title or Position	:	COO
Name	:	THOMAS CRAWFORD
Credential	:
Telephone Number	:	843-792-8775

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	08/24/2022

Similar Medicare Providers

1801752696 — ERICA LORRAINE TOLLERSON
Practice Location Address:

25 COURTENAY DR
CHARLESTON, SC
29425-8911

Practice Phone: 843-792-2900
Practice Fax:

1326048117 — MARIANNE FIUTEM CRNA
Practice Location Address:

25 COURTENAY DR
CHARLESTON, SC
29425-8911

Practice Phone: 843-876-4444
Practice Fax:

1134193063 — DONNA EMBREY CRNA
Practice Location Address:

25 COURTENAY DR , SUITE #4200 MSC240
CHARLESTON, SC
29425-8911

Practice Phone: 843-876-5745
Practice Fax:

1326060385 — LARRY CLARK FIELD MD
Practice Location Address:

25 COURTENAY DR , SUITE 4200
CHARLESTON, SC
29425-8911

Practice Phone: 834-876-5744
Practice Fax:

1912091802 — DR. TRACIE SANNICANDRO OSGOOD PHARMD
Practice Location Address:

25 COURTENAY DR , SECOND FLOOR ASHLEY RIVER TOWER PHARMACY
CHARLESTON, SC
29425-8911

Practice Phone: 843-876-5588
Practice Fax:

1407065998 — DR. BARBARA S WIGGINS PHARM.D.,
Practice Location Address:

25 COURTENAY DR
CHARLESTON, SC
29425-8911

Practice Phone: 843-876-5597
Practice Fax: 843-876-5401

Directions to “MEDICAL UNIVERSITY HOSPITAL AUTHORITY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.