Provider Demographics
NPI:1578940847
Name:HYPERTENSION AND DIABETES PREVENTION AND TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:HYPERTENSION AND DIABETES PREVENTION AND TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITONER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:COE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:843-968-8333
Mailing Address - Street 1:118 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532
Mailing Address - Country:US
Mailing Address - Phone:843-968-8333
Mailing Address - Fax:
Practice Address - Street 1:118 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532
Practice Address - Country:US
Practice Address - Phone:843-968-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN 1734261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service