NPIMap

Organization Active NPI

Asy Absolute Wellness Clinic, LLC

  • Specialist
  • Columbia, SC
National Provider Identifier
1285922336
Registry record updated Jun 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
GP5785
Legal business name
ASY ABSOLUTE WELLNESS CLINIC, LLC
Practice address
2712 Middleburg Dr
Suite 206
Columbia, SC 29204-2415
Phone
(803) 335-1272
Fax
(803) 335-1272
NPI assigned
Jul 11, 2011
Last updated
Jun 18, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2013

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

Authorized official

Name
Mr. Christopher Young, M.E.D
Title
Partner/Staff
Phone
(803) 335-1272

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X GP5785 Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 22943 SC
Clinical Medical Laboratory 291U00000X 42D2033880 SC

Addresses

Primary practice location

2712 Middleburg Dr
Suite 206
Columbia, SC 29204-2415

Mailing address

2712 Middleburg Dr
Suite 206
Columbia, SC 29204-2415
Phone (803) 335-1272

Other identifiers 1

IdentifierTypeStateIssuer
GP5785MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1310342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371513600000",
    "number": "1285922336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2712 MIDDLEBURG DR",
            "address_2": "SUITE 206",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042415",
            "telephone_number": "803-335-1272",
            "fax_number": "803-335-1272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2712 MIDDLEBURG DR",
            "address_2": "SUITE 206",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042415",
            "telephone_number": "803-335-1272",
            "fax_number": "803-335-1272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASY ABSOLUTE WELLNESS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-11",
        "last_updated": "2013-06-18",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PARTNER/STAFF",
        "authorized_official_telephone_number": "803-335-1272",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.E.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": "GP5785",
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "SC",
            "license": "22943",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "SC",
            "license": "42D2033880",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5785",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2013; 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.