Provider Demographics
NPI:1871503011
Name:CAMDEN ASSOCIATED PHYSICIANS, P.A.
Entity Type:Organization
Organization Name:CAMDEN ASSOCIATED PHYSICIANS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HULTEEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:803-432-1478
Mailing Address - Street 1:1007 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4211
Mailing Address - Country:US
Mailing Address - Phone:803-432-1478
Mailing Address - Fax:803-432-4212
Practice Address - Street 1:1007 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4211
Practice Address - Country:US
Practice Address - Phone:803-432-1478
Practice Address - Fax:803-432-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC692111N00000X, 111NX0800X
SC7414208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH255Medicaid
SCGCH255Medicaid