Provider Demographics
NPI:1891708699
Name:VEGA HEALTHCARE INC.
Entity Type:Organization
Organization Name:VEGA HEALTHCARE INC.
Other - Org Name:HAMPTON PEDIATRICS AND FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:R
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-943-3813
Mailing Address - Street 1:408 JACKSON AVE E
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:SC
Mailing Address - Zip Code:29924-3602
Mailing Address - Country:US
Mailing Address - Phone:803-943-3813
Mailing Address - Fax:803-943-5971
Practice Address - Street 1:408 JACKSON AVE E
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924-3602
Practice Address - Country:US
Practice Address - Phone:803-943-3813
Practice Address - Fax:803-943-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23033207Q00000X
SC28595208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4422Medicaid