NPIMap

Organization Active NPI

Kershawhealth

Doing business as Kershawhealth Primary Care at Camden

  • Family Medicine Physician
  • Camden, SC
National Provider Identifier
1164834487
Registry record updated May 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
HTL 0101 Issued in SC
Legal business name
KERSHAWHEALTH
Doing business as
Kershawhealth Primary Care at Camden
Practice address
1111 Mill St
Camden, SC 29020-3763
Phone
(803) 432-4311
NPI assigned
May 21, 2014
Organization subpart
Yes
Parent organization
KERSHAWHEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 21, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael L Bunch
Title
Evp-Coo & Cfo
Phone
(803) 713-2496

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X HTL 0101 SC Primary

Addresses

Primary practice location

1111 Mill St
Camden, SC 29020-3763

Mailing address

1111 Mill St
Camden, SC 29020-3763

Other identifiers 2

IdentifierTypeStateIssuer
3410OtherSCMEDICARE PTAN #
400480MedicaidSC

Other names 1

  • KERSHAWHEALTH PRIMARY CARE AT CAMDEN Doing business as

National Provider Directory

National Provider Directory
Part of
Kershaw County Medical

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400630400000",
    "number": "1164834487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 MILL ST",
            "city": "CAMDEN",
            "state": "SC",
            "postal_code": "290203763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 MILL ST",
            "city": "CAMDEN",
            "state": "SC",
            "postal_code": "290203763",
            "telephone_number": "803-432-4311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERSHAWHEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KERSHAWHEALTH",
        "enumeration_date": "2014-05-21",
        "last_updated": "2014-05-21",
        "status": "A",
        "authorized_official_last_name": "BUNCH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EVP-COO & CFO",
        "authorized_official_telephone_number": "803-713-2496"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "HTL 0101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN #",
            "identifier": "3410",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400480",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KERSHAWHEALTH PRIMARY CARE AT CAMDEN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Camden, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.