Provider Demographics
NPI:1225593924
Name:MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Other - Org Name:MUSC CHILDRENS PEE DEE PEDIATRICS MARION MEDICAL PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-876-1344
Mailing Address - Street 1:PO BOX 936801
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6801
Mailing Address - Country:US
Mailing Address - Phone:843-792-2300
Mailing Address - Fax:
Practice Address - Street 1:2845 E HIGHWAY 76 STE 5
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-6037
Practice Address - Country:US
Practice Address - Phone:843-431-2650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty