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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