DR. SHANE R MULL M.D. NPI 1699786079

NPI Information

  • NPI: 1699786079
  • Provider Name: DR. SHANE R MULL, M.D.
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 3209 COLONIAL DR
    USC- FAMILY & PREVENTIVE MEDICINE
    COLUMBIA, SC
    ZIP 29203
  • Phone: (803) 434-6113

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NPI Details

DR. Shane R Mull, M.D. is a family medicine in Columbia, SC. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Shane R Mull, M.D. NPI is 1699786079. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3209 COLONIAL DR
USC- FAMILY & PREVENTIVE MEDICINE
COLUMBIA, SC
ZIP 29203-930
Phone: (803) 434-6113
Fax: (803) 434-7231

The NPI 1699786079 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/10/2006 and was last updated on 3/26/2015.

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
1207P00000XEmergency Medicine23962SOUTH CAROLINANo
2207Q00000XFamily Medicine2009-01329NORTH CAROLINANo
3207Q00000XFamily Medicine23962SOUTH CAROLINAYes

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
1AA05962353MEDICARE PINSOUTH CAROLINA
2AA05696125MEDICARE PINSOUTH CAROLINA
3AA05696201MEDICARE PINSOUTH CAROLINA
4AA05696126MEDICARE PINSOUTH CAROLINA
5AA05697136MEDICARE PINSOUTH CAROLINA
6LL4378MEDICAIDSOUTH CAROLINA
7AA05694713MEDICARE PINSOUTH CAROLINA
8AA05692461MEDICARE PINSOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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