Organization
SOUTH CAROLINA PHS PC
Active
Parent organization
PROVIDER HEALTH SERVICES LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDER HEALTH SERVICES LLC
Authorized official
NICOLE HOWARD (CFO)
(337) 991-9276
Entity
Organization
Contact information
Practice address
6650 RIVERS AVE, NORTH CHARLESTON, SC 29406-4809
(877) 260-4747
Mailing address
1509 DULLES DRIVE, LAFAYETTE, LA 70506
(337) 991-9276
(337) 991-9288
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP5622
—
SC
Enumeration date
01/28/2011
Last updated
07/02/2014
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