Provider Demographics
NPI:1609273549
Name:HOUSECALLS-MD
Entity Type:Organization
Organization Name:HOUSECALLS-MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSAC-PAVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-501-2031
Mailing Address - Street 1:7075 CROSS COUNTY RD UNIT 41180
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29423-3348
Mailing Address - Country:US
Mailing Address - Phone:843-501-2031
Mailing Address - Fax:843-884-6146
Practice Address - Street 1:1305 HORSESHOE BND
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7406
Practice Address - Country:US
Practice Address - Phone:843-501-2031
Practice Address - Fax:843-884-6146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
SCSC35609310400000X, 315D00000X
SCSC1314363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, InpatientGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC23010821Medicare PIN