Provider Demographics
NPI:1497249874
Name:TESTING
Entity Type:Organization
Organization Name:TESTING
Other - Org Name:TESTING SUPPLIER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHIRVELLA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CONTRACTOR
Authorized Official - Phone:843-229-5626
Mailing Address - Street 1:4100 N MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5800
Mailing Address - Country:US
Mailing Address - Phone:843-229-5626
Mailing Address - Fax:803-814-2520
Practice Address - Street 1:4100 N MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5800
Practice Address - Country:US
Practice Address - Phone:843-229-5626
Practice Address - Fax:803-814-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC119254555261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC119254555OtherCONTRACTOR