Provider Demographics
NPI:1831392836
Name:MARK P. ROLLINS MD OF SOUTH CAROLINA PC
Entity type:Organization
Organization Name:MARK P. ROLLINS MD OF SOUTH CAROLINA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-428-6909
Mailing Address - Street 1:10401 N MERIDIAN ST
Mailing Address - Street 2:STE 310
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1151
Mailing Address - Country:US
Mailing Address - Phone:317-429-6909
Mailing Address - Fax:
Practice Address - Street 1:1822 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6253
Practice Address - Country:US
Practice Address - Phone:866-605-4222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty