Provider Demographics
NPI:1396710166
Name:WEIRCOX, KAYLENE D (MD)
Entity type:Individual
Prefix:
First Name:KAYLENE
Middle Name:D
Last Name:WEIRCOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAYLENE
Other - Middle Name:
Other - Last Name:WEIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-0062
Mailing Address - Country:US
Mailing Address - Phone:803-779-3222
Mailing Address - Fax:803-779-3223
Practice Address - Street 1:3019 FARROW RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-7001
Practice Address - Country:US
Practice Address - Phone:803-779-3222
Practice Address - Fax:803-779-3223
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26856208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC268560Medicaid
SCAA06338637Medicare PIN
SCAA06338523Medicare PIN
SCI16803Medicare UPIN