Provider Demographics
NPI: | 1821512302 |
---|---|
Name: | ARCIS HEALTHCARE, LLC |
Entity Type: | Organization |
Organization Name: | ARCIS HEALTHCARE, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | DONALD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BECKER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 843-797-5050 |
Mailing Address - Street 1: | 2880 TRICOM ST |
Mailing Address - Street 2: | |
Mailing Address - City: | NORTH CHARLESTON |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29406-9171 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 843-797-5050 |
Mailing Address - Fax: | 843-797-3633 |
Practice Address - Street 1: | 1951 CLEMENTS FERRY RD STE 100 |
Practice Address - Street 2: | |
Practice Address - City: | CHARLESTON |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29492-7724 |
Practice Address - Country: | US |
Practice Address - Phone: | 843-797-5050 |
Practice Address - Fax: | 843-797-3633 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-07-27 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 207QS0010X, 207X00000X, 207XS0106X, 207XS0114X, 207XS0117X, 207XX0004X, 207XX0005X, 208100000X, 2081P2900X, 363AM0700X, 363AS0400X, 363LA2200X, 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Single Specialty | |
No | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | Group - Single Specialty |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Single Specialty |
No | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | Group - Single Specialty |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Single Specialty |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Single Specialty |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Single Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Single Specialty | |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Single Specialty |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Single Specialty |
No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Single Specialty |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Single Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | GP6337 | Medicaid |