Provider Demographics
NPI:1629780895
Name:MUSSER, JOHN CHARLES
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:MUSSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 WINDBLOWN PL
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-9267
Mailing Address - Country:US
Mailing Address - Phone:803-487-0708
Mailing Address - Fax:
Practice Address - Street 1:205 PIEDMONT BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1836
Practice Address - Country:US
Practice Address - Phone:803-327-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7HH6-MPO-WT79OtherMEDICARE