Provider Demographics
NPI:1639590359
Name:USC TELEHEALTH
Entity Type:Organization
Organization Name:USC TELEHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSW INTERN
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-843-3239
Mailing Address - Street 1:818 ASHTON POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-6024
Mailing Address - Country:US
Mailing Address - Phone:850-843-3239
Mailing Address - Fax:850-770-1084
Practice Address - Street 1:818 ASHTON POINTE BLVD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-6024
Practice Address - Country:US
Practice Address - Phone:850-843-3239
Practice Address - Fax:850-770-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10143251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management