Organization
ETHER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KARLA G SHREVE (MANAGER)
(803) 788-1100
Entity
Organization
Contact information
Practice address
1070 WILDWOOD CENTRE DR, COLUMBIA, SC 29229-8420
(803) 788-1100
(803) 788-4522
Mailing address
1070 WILDWOOD CENTRE DR, COLUMBIA, SC 29229-8420
(803) 788-1100
(803) 788-4522
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP6725
—
SC
Enumeration date
12/04/2014
Last updated
04/17/2015
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