Provider Demographics
NPI:1336105527
Name:HEALTH PROMOTION SPECIALISTS
Entity Type:Organization
Organization Name:HEALTH PROMOTION SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:O
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:803-348-2973
Mailing Address - Street 1:100 OLD CHEROKEE RD
Mailing Address - Street 2:SUITE F, BOX 14
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7959
Mailing Address - Country:US
Mailing Address - Phone:803-808-2950
Mailing Address - Fax:803-808-5642
Practice Address - Street 1:100 OLD CHEROKEE RD
Practice Address - Street 2:SUITE F, BOX 14
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7959
Practice Address - Country:US
Practice Address - Phone:803-808-2304
Practice Address - Fax:803-808-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC927124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9670Medicaid
SC187113Medicaid
SC187113Medicaid