Provider Demographics
NPI:1245296433
Name:NEGASH, YOHANNES (MD)
Entity type:Individual
Prefix:
First Name:YOHANNES
Middle Name:
Last Name:NEGASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SC HOUSE CALLS INC
Mailing Address - Street 2:111 DOCTORS CIRCLE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:SC HOUSE CALLS INC
Practice Address - Street 2:111 DOCTORS CIRCLE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:803-434-3955
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20026208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC200268Medicaid
SCGP3800OtherGROUP MCAID NUMBER
SC200268Medicaid
SCSC05805773Medicare UPIN
SCG840517805Medicare ID - Type Unspecified
SC200268Medicaid
SCSC05807579Medicare PIN