Provider Demographics
NPI:1285667824
Name:ANMED HEALTH
Entity Type:Organization
Organization Name:ANMED HEALTH
Other - Org Name:ANMED PEDIATRICS - FANT STREET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-512-1109
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-3954
Mailing Address - Fax:864-125-3952
Practice Address - Street 1:500 N FANT ST
Practice Address - Street 2:SUITE C
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5702
Practice Address - Country:US
Practice Address - Phone:864-225-7798
Practice Address - Fax:864-260-3952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3165Medicaid
SCGP3165Medicaid