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Organization
ROPER HOSPITAL, INC.
Active
Organization
ROPER HOSPITAL, INC.
Active
Other names
Vascular Medicine and Wound Management Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM ANTHONY JACKSON (CEO)
(843) 724-2954
Entity
Organization
Contact information
Practice address
300 CALLEN BLVD STE 220, SUMMERVILLE, SC 29486-2816
(843) 724-2289
(843) 606-8038
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(888) 472-0043
(843) 724-2454
Taxonomy
Speciality
Code
Description
License number
State
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP7573
—
SC
Enumeration date
11/02/2016
Last updated
03/17/2024
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