Provider Demographics
NPI:1952065989
Name:INSTANT FOR INSTANCE LLC
Entity Type:Organization
Organization Name:INSTANT FOR INSTANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETAGAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-205-9024
Mailing Address - Street 1:115 LOCHAVEN DR APT 302
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6060
Mailing Address - Country:US
Mailing Address - Phone:843-205-9024
Mailing Address - Fax:
Practice Address - Street 1:1064 GARDNER RD STE 313B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5746
Practice Address - Country:US
Practice Address - Phone:843-205-9024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty