MEDICARE: CAVES MEDICAL & REHABILITATION CENTER INC

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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1891007332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAVES MEDICAL & REHABILITATION CENTER INC

Provider Business Mailing Address
First Line	:	2757 LAUREL ST
Second Line	:	STE 4
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2037
Country	:	US
Telephone Number	:	803-252-4966
Fax Number	:

Provider Business Practice Location Address
First Line	:	2757 LAUREL ST
Second Line	:	STE 4A
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2037
Country	:	US
Telephone Number	:	803-252-4966
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS VIRGINIA K SAMUEL
Credential	:	DC
Telephone Number	:	803-252-4966

Provider Enumeration Date	:	07/13/2010
Last Update Date	:	07/13/2010

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