Provider Demographics
NPI:1669950903
Name:MEDICAL UNIVERSITY OF SOUTH CAROLINA
Entity type:Organization
Organization Name:MEDICAL UNIVERSITY OF SOUTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BLUMENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-792-3664
Mailing Address - Street 1:30 BEE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8900
Mailing Address - Country:US
Mailing Address - Phone:843-792-3664
Mailing Address - Fax:
Practice Address - Street 1:30 BEE ST STE 102
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8910
Practice Address - Country:US
Practice Address - Phone:843-792-3664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health