MEDICALLY FRAGILE CHILDRENS PROGRAM (NPI# 1023153996) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023153996 |
| Entity Type | Organization |
| Organization Name | MEDICALLY FRAGILE CHILDRENS PROGRAM |
| Other Organization Name | MEDICAL UNIVERSITY HOSPITAL AUTHORITY |
| Practice Address |
2750 Speissegger Drive Suite 108 N Charleston SC 29405-8701 |
| Practice Telephone | 8438767007 |
| Practice Fax Number | 8435549230 |
| Mailing Telephone | 8438767007 |
| Mailing Fax Number | 8435549230 |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. WILLIAM STUART SMITH (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8437924000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | DRC009 | 05 |
| Other Name | Type Code |
|---|---|
| Medical University Hospital Authority | Other Name - Individual/Organization |
| Street Address |
2750 SPEISSEGGER DRIVE SUITE 108 |
| City | N CHARLESTON |
| State | SC |
| Zip Code | 29405-8701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134720535 | Detyens Medical Center | Pharmacy | 1670 Drydock Avenue, Building 10, Suite A, North Charleston, SC 29405 | 2020-11-03 |
| 1013422674 | Caroline Rae | Speech-Language Pathologist | 3100 Carner Avenue, Charleston, SC 29405 | 2017-12-05 |
| 1245685171 | Ethel Jane Amerson | Registered Nurse | 3180 Thomasena Mcpherson Blvd, Nursing Module, Charleston County School Districe, North Charleston, SC 29405 | 2016-04-28 |
| 1750755468 | Diane Levesque | Registered Nurse | 4050 Bridgeview Drive, Suite 600, North Charleston, SC 29405 | 2015-11-18 |
| 1063813111 | Trident Medical Center, LLC | Clinic/Center | 5249 Emmett I. Davis Jr. Avenue, North Charleston, SC 29405 | 2014-09-09 |
| 1114344504 | Bonita Davies | Registered Nurse | 3180 Thomasina Mcpherson Boulevard, North Charleston, SC 29405 | 2014-03-24 |
| 1427493261 | Melissa Hancock D'arcy | Registered Nurse | 3750 Dorchester Road, N. Charleston, SC 29405 | 2013-05-07 |
| 1427308824 | Terri Timmerman | Pharmacist | 1506 Montague Ave, North Charleston, SC 29405 | 2012-09-12 |
| 1649414285 | Roper Saint Francis Physicians Network | Clinical Medical Laboratory | 4450 Leeds Place West, Suite A, North Charleston, SC 29405 | 2009-04-27 |
| 1891940649 | Earnestine Roberts | Registered Nurse | 3605 Meeting Street Rd., Ste.b1, North Charleston, SC 29405 | 2008-11-20 |
| Find all providers in zip 29405 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114561206 | Teresa White | Clinic/Center | 398 Old South Rd, Duncan, SC 29334-9266 | 2019-10-31 |
| 1144782640 | Williamsburg County Disabilities and Special Needs Board | Clinic/Center | 61 Greenlee St, Kingstree, SC 29556-6136 | 2019-04-03 |
| 1124414495 | Sunshine Pediatric Therapy of South Carolina | Clinic/Center | 5 Ivy Lawn Pl, Greenville, SC 29605-6522 | 2015-04-13 |
| 1225346737 | Carolina Developmental Clinic, LLC | Clinic/Center | 107 Vista Oaks Dr Ste C, Lexington, SC 29072-8230 | 2010-09-17 |
| 1396064382 | Palmetto Pediatric Ot, LLC | Clinic/Center | 2427 Old Lexington Highway, Chapin, SC 29036 | 2010-05-31 |
| 1043394976 | Carolina Autism Supported Living Services | Clinic/Center | 4 Carriage Ln Ste 302, Charleston, SC 29407-6050 | 2006-10-25 |
| 1831639459 | Upstate Affiliate Organization | Clinic/Center | 249 N Grove Medical Park Dr, #300, Spartanburg, SC 29303-4227 | 2017-03-01 |
| 1396291407 | Prisma Health-upstate | Clinic/Center | 29 N Academy St, Greenville, SC 29601-2629 | 2016-08-29 |
| 1336695436 | Prisma Health-upstate | Clinic/Center | 29 N Academy St, Greenville, SC 29601-2629 | 2016-08-29 |
| 1073521951 | Greenville Health System | Clinic/Center | 29 N Academy St, Greenville, SC 29601-2629 | 2006-08-04 |
| Find all providers with the same taxonomy | ||||
| City | N CHARLESTON |
| Zip Code | 29405 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.