Provider Demographics
NPI:1750609889
Name:KERSHAWHEALTH
Entity type:Organization
Organization Name:KERSHAWHEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-713-6227
Mailing Address - Street 1:1 WINDSOR CV
Mailing Address - Street 2:SUITE 402
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-1833
Mailing Address - Country:US
Mailing Address - Phone:803-788-5916
Mailing Address - Fax:803-788-9564
Practice Address - Street 1:1165 HIGHWAY 1 S
Practice Address - Street 2:SUITE 500
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-8966
Practice Address - Country:US
Practice Address - Phone:803-438-3800
Practice Address - Fax:803-438-3898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KERSHAWHEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-13
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC369382Medicaid
SC400480Medicaid
SC328735Medicaid
420048Medicare Oscar/Certification
SC369382Medicaid