Provider Demographics
NPI:1033527171
Name:PAGE, TANYA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-3349
Mailing Address - Country:US
Mailing Address - Phone:843-495-4138
Mailing Address - Fax:
Practice Address - Street 1:220 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-3349
Practice Address - Country:US
Practice Address - Phone:843-495-4138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home