Provider Demographics
NPI:1306037676
Name:PHYSICIANS HEALTH & INJURY CLINIC
Entity Type:Organization
Organization Name:PHYSICIANS HEALTH & INJURY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DC
Authorized Official - Prefix:
Authorized Official - First Name:DUANGMANI
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-773-3421
Mailing Address - Street 1:711 BULTMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150
Mailing Address - Country:US
Mailing Address - Phone:803-773-3421
Mailing Address - Fax:803-773-8458
Practice Address - Street 1:711 BULTMAN DRIVE
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150
Practice Address - Country:US
Practice Address - Phone:803-773-3421
Practice Address - Fax:803-773-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1773111N00000X
SC1857111N00000X
SC7414208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty