Provider Demographics
NPI:1790111094
Name:UNIVERSITY OF SOUTH CAROLINA AIKEN
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTH CAROLINA AIKEN
Other - Org Name:USCA SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST ATHLETIC DIR/SPORTS MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:AIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:ATC, CSCS
Authorized Official - Phone:803-641-3441
Mailing Address - Street 1:471 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6389
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:471 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6389
Practice Address - Country:US
Practice Address - Phone:803-641-3486
Practice Address - Fax:803-641-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty