INTERCOSTAL NONSURGICAL DIAGNOSTIC INC (NPI# 1407397227) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407397227 |
| Entity Type | Organization |
| Organization Name | INTERCOSTAL NONSURGICAL DIAGNOSTIC INC |
| Practice Address |
24 E Main St Williamston SC 29697-1925 |
| Practice Telephone | 8648476020 |
| Practice Fax Number | 8648409668 |
| Mailing Telephone | 8648476020 |
| Mailing Fax Number | 8648409668 |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2017-03-13 |
| Authorized Official Name | JACK WISE (OWNER) |
| Authorized Official Telephone | 8648476020 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 405300000X | Prevention Professional | Other Service Providers |
| Street Address |
24 E MAIN ST |
| City | WILLIAMSTON |
| State | SC |
| Zip Code | 29697-1925 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306201728 | Candra Rich | Plastic Surgery | 24 E Main St, Williamston, SC 29697-1925 | 2015-12-30 |
| 1992803043 | Kevin Walter Burnham | Physician Assistant | 24 E Main St, Williamston, SC 29697-1925 | 2006-09-20 |
| 1427018159 | Thomas Arthur Malone | Family Medicine | 24 E Main St, Williamston, SC 29697-1925 | 2006-03-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760893705 | Daniel Alexander Ellis | Occupational Therapy Assistant | 801 N. Hamilton St., Williamston, SC 29697 | 2014-05-13 |
| 1093134108 | Luz Brown | Pharmacist | 102 Wood Stream Way, Williamston, SC 29697 | 2014-04-16 |
| 1144644410 | Lynne Phillips | Registered Nurse | 804 N. Hamilton Street, Williamston, SC 29697 | 2014-02-07 |
| 1396969556 | Ambucare Ambulance LLC. | Non-emergency Medical Transport (VAN) | 303 Beaverdam Road, Williamston, SC 29697 | 2007-04-12 |
| 1275676892 | Jorge Antonio Perdomo | Social Worker | 900 Greenville Drive, Williamston, SC 29697 | 2007-02-14 |
| 1245301985 | Complete Healing & Wellness Center P.a. | Chiropractor | 24 East Main St, Williamston, SC 29697 | 2006-11-13 |
| 1255402905 | Jack D Wise Jr. | Chiropractor | 24 East Main Street, Williamston, SC 29697 | 2006-11-13 |
| 1285839563 | Lou Wingo Rogers | Counselor | 900 Greenville Drive, Williamston, SC 29697 | 2007-06-18 |
| 1578634218 | Marylouise Schultz Wise | Chiropractor | 24 East Main St, Williamston, SC 29697 | 2006-11-13 |
| 1447654363 | New Dominion Community Services LLC | Counselor | 900 Greenville Drive, Williamston, SC 29697-0000 | 2014-10-21 |
| Find all providers in zip 29697 | ||||
| Taxonomy Code | 405300000X |
| Grouping | Other Service Providers |
| Classification | Prevention Professional |
| Prevention Professionals work in programs aimed to address specific patient needs, such as suicide prevention, violence prevention, alcohol avoidance, drug avoidance, and tobacco prevention. The goal of the program is to reduce the risk of relapse, injury, or re-injury of the patient. Prevention Professionals work in a variety of settings and provide appropriate case management, mediation, referral, and mentorship services. Individuals complete prevention professionals training for the population of patients with whom they work. |
| Notes: Source: National Uniform Claim Committee, 2015 [1/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265043319 | Mary Evelyn Horn | Prevention Professional | 150 Brooke Lee Cir, Taylors, SC 29687-5955 | 2020-08-12 |
| 1841847951 | Jeffrey Wright | Prevention Professional | 4 Andromeda Ct, Greenville, SC 29615-5433 | 2019-08-22 |
| 1316473952 | Ana Hancock | Prevention Professional | 701 Coventry Ln, A-5, Florence, SC 29501-8893 | 2017-05-02 |
| 1134654494 | Cannady Agency Inc. | Prevention Professional | 305 E Washington St, Walterboro, SC 29488-3919 | 2017-04-25 |
| 1821522913 | Kayla Price | Prevention Professional | 1942 Old Dutch Rd, Little Mountain, SC 29075-8870 | 2017-04-14 |
| 1023559382 | Tania Morrall | Prevention Professional | 8116 Ronda Dr, Charleston, SC 29406-8928 | 2017-03-19 |
| 1619418795 | Cameron Motsinger | Prevention Professional | 994 Stono River Dr, Charleston, SC 29412-8633 | 2017-03-09 |
| City | WILLIAMSTON |
| Zip Code | 29697 |
Please comment or provide details below to improve the information on INTERCOSTAL NONSURGICAL DIAGNOSTIC INC.
| 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.