Provider Demographics
NPI:1568001642
Name:UNIFIED FAMILY HEALTH CENTER LLC
Entity Type:Organization
Organization Name:UNIFIED FAMILY HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCHIT
Authorized Official - Suffix:
Authorized Official - Credentials:CBCS
Authorized Official - Phone:864-626-3374
Mailing Address - Street 1:1032A KINLEY RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9632
Mailing Address - Country:US
Mailing Address - Phone:803-732-6635
Mailing Address - Fax:803-461-0655
Practice Address - Street 1:1032A KINLEY RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9632
Practice Address - Country:US
Practice Address - Phone:803-732-6635
Practice Address - Fax:803-461-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2898OtherMEDICAL LICENSE