Provider Demographics
NPI:1033393954
Name:E FAMILY MEDICIN GRP
Entity Type:Organization
Organization Name:E FAMILY MEDICIN GRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTRANT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:F
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA,RPH
Authorized Official - Phone:843-792-8451
Mailing Address - Street 1:295 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8904
Mailing Address - Country:US
Mailing Address - Phone:843-792-8451
Mailing Address - Fax:843-792-9081
Practice Address - Street 1:295 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8904
Practice Address - Country:US
Practice Address - Phone:843-792-3064
Practice Address - Fax:843-792-3605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUSC FAMILY MEDICINE PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-27
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50000863261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0511232OtherBLUECROSSBLUESHIELD GA
0004202812OtherRXAMERICA
SC708630Medicaid
SC4202812OtherNCPDP
SCDPE044OtherMEDICAID DME