Provider Demographics
NPI:1184710287
Name:AIKEN INTEGRATED MEDICAL, PC
Entity type:Organization
Organization Name:AIKEN INTEGRATED MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:CHRISTENSEN
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-644-7897
Mailing Address - Street 1:37 VARDEN DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5297
Mailing Address - Country:US
Mailing Address - Phone:803-644-7897
Mailing Address - Fax:803-643-3026
Practice Address - Street 1:37 VARDEN DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5297
Practice Address - Country:US
Practice Address - Phone:803-644-7897
Practice Address - Fax:803-643-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCH2685111NN0400X
SC19409207Q00000X
SC4792225100000X
SCCH1305111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1305Medicaid
SCGCH374Medicaid
SCGP3388Medicaid
SCCH2685Medicaid
SC194097Medicaid
SCGP4283Medicaid
SCTH1627Medicaid
SCGCH374Medicaid
SCU58987Medicare UPIN
SCTH1627Medicaid
SCG89122Medicare UPIN
SC194097Medicaid