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Organization
KERSHAWHEALTH
Active
Organization
KERSHAWHEALTH
Active
Parent organization
KERSHAWHEALTH
Other names
KERSHAWHEALTH PRIMARY CARE AT CAMDEN
Organization subpart
Yes
Provider details
NPI number
Legal business name
KERSHAWHEALTH
Authorized official
MICHAEL L BUNCH (EVP-COO & CFO)
(803) 713-2496
Entity
Organization
Contact information
Practice address
1111 MILL ST, CAMDEN, SC 29020-3763
(803) 432-4311
Mailing address
1111 MILL ST, CAMDEN, SC 29020-3763
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
HTL 0101
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3410
MEDICARE PTAN #
SC
05
—
400480
—
SC
Enumeration date
05/21/2014
Last updated
05/21/2014
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