Provider Demographics
NPI:1013021153
Name:HIGGINS, EDMUND S (MD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:S
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 918
Mailing Address - Street 2:1035 CHERAW ST.
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512
Mailing Address - Country:US
Mailing Address - Phone:843-454-0841
Mailing Address - Fax:843-454-0635
Practice Address - Street 1:1035 CHERAW ST.
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512
Practice Address - Country:US
Practice Address - Phone:843-556-4157
Practice Address - Fax:843-763-8747
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12478174400000X
SCMD12478174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC405127Medicaid
SC405127Medicaid
SC3343Medicare PIN