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NPI Code Detail

MEDICARE: VICKI S ROBERTS P.A.-C

MEDICARE: VICKI S ROBERTS P.A.-C
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
1363A00000XPhysician AssistantA609DSC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20301242OTHERSCCAROLINA CARE PLAN

General Provider Information

NPI Number : 1952379471
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICKI S ROBERTS P.A.-C
Provider Business Mailing Address
First Line : 3574 SUNSET BLVD
Second Line :
City : WEST COLUMBIA
State : SC
Zip : 29169-3044
Country : US
Telephone Number : 803-796-2500
Fax Number : 803-796-4378
Provider Business Practice Location Address
First Line : 3574 SUNSET BLVD
Second Line :
City : WEST COLUMBIA
State : SC
Zip : 29169-3044
Country : US
Telephone Number : 803-796-2500
Fax Number : 803-796-4378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 01/17/2012

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Directions to “ VICKI S ROBERTS P.A.-C” Practice Location

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