Provider Demographics
NPI:1790885747
Name:KULBERSH WOMEN'S CENTER, LLC
Entity Type:Organization
Organization Name:KULBERSH WOMEN'S CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:KULBERSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-732-4608
Mailing Address - Street 1:1 WELLNESS BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2871
Mailing Address - Country:US
Mailing Address - Phone:803-732-4608
Mailing Address - Fax:803-732-4692
Practice Address - Street 1:1 WELLNESS BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2871
Practice Address - Country:US
Practice Address - Phone:803-732-4608
Practice Address - Fax:803-732-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3794Medicaid
SCGP3794Medicaid