Provider Demographics
NPI:1003915877
Name:EAST AIKEN HEALTH CENTER L.L.C.
Entity Type:Organization
Organization Name:EAST AIKEN HEALTH CENTER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KULE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-644-7033
Mailing Address - Street 1:1847 HATCHAWAY BRIDGE RD
Mailing Address - Street 2:EAST AIKEN HEALTH CENTER
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29805-8163
Mailing Address - Country:US
Mailing Address - Phone:803-644-7033
Mailing Address - Fax:803-644-8250
Practice Address - Street 1:1847 HATCHAWAY BRIDGE RD
Practice Address - Street 2:EAST AIKEN HEALTH CENTER
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29805-8163
Practice Address - Country:US
Practice Address - Phone:803-644-7033
Practice Address - Fax:803-644-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty