Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 276400000X | Rehabilitation, Substance Use Disorder Unit | | | | No |
| 2 | 367500000X | Nurse Anesthetist, Certified Registered | | | SOUTH CAROLINA | No |
| 3 | 207P00000X | Emergency Medicine | | | SOUTH CAROLINA | No |
| 4 | 363A00000X | Physician Assistant | | | SOUTH CAROLINA | No |
| 5 | 225100000X | Physical Therapist | | | | No |
| 6 | 363L00000X | Nurse Practitioner | | | SOUTH CAROLINA | No |
| 7 | 235Z00000X | Speech-Language Pathologist | | | | No |
| 8 | 282NW0100X | General Acute Care Hospital | Women | | | No |
| 9 | 225X00000X | Occupational Therapist | | | | No |
| 10 | 282N00000X | General Acute Care Hospital | | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 117031 | MEDICAID | SOUTH CAROLINA | |
| 2 | 20048941 | MEDICAID | SOUTH CAROLINA | |
| 3 | 000000041A | MEDICAID | GEORGIA | |
| 4 | 4200027 | MEDICAID | NORTH CAROLINA | |
| 5 | ========= | OTHER | SOUTH CAROLINA | BLUE CROSS - WELLSPRING |
| 6 | 450780 | MEDICAID | SOUTH CAROLINA | |
| 7 | ========= | OTHER | SOUTH CAROLINA | BLUE CROSS - GENERAL HOSP |
| 8 | 20003692 | MEDICAID | SOUTH CAROLINA | |
| 9 | ========= | OTHER | SOUTH CAROLINA | BLUE CROSS-MULTISPECIALTY |
| 10 | 10046726 | MEDICAID | VIRGINIA | |
