Provider Demographics
NPI:1174867857
Name:FEDERAL CORRECTIONAL INS ESTILL
Entity Type:Organization
Organization Name:FEDERAL CORRECTIONAL INS ESTILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-625-4607
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:100 PRISON RD
Mailing Address - City:ESTILL
Mailing Address - State:SC
Mailing Address - Zip Code:29918-0699
Mailing Address - Country:US
Mailing Address - Phone:803-625-4607
Mailing Address - Fax:803-625-5603
Practice Address - Street 1:100 PRISON ROAD
Practice Address - Street 2:
Practice Address - City:ESTILL
Practice Address - State:SC
Practice Address - Zip Code:29918-0699
Practice Address - Country:US
Practice Address - Phone:803-625-4607
Practice Address - Fax:803-625-5603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health