Provider Demographics
NPI:1083149330
Name:BROADSTEP ACADEMY- SOUTH CAROLINA INC
Entity Type:Organization
Organization Name:BROADSTEP ACADEMY- SOUTH CAROLINA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:KEDRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-709-0197
Mailing Address - Street 1:1991 GLENNS BAY RD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-8614
Mailing Address - Country:US
Mailing Address - Phone:843-215-0242
Mailing Address - Fax:
Practice Address - Street 1:1399 HARMONY CAMP RD
Practice Address - Street 2:
Practice Address - City:GREELEYVILLE
Practice Address - State:SC
Practice Address - Zip Code:29056-9666
Practice Address - Country:US
Practice Address - Phone:843-473-4656
Practice Address - Fax:843-473-4676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
SCSC18446261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty