Executor Diagnostics

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

EXECUTOR DIAGNOSTICS

Practice address

1929 Mountain Laurel CT # a
Florence, SC 29505-6053

Phone

(843) 292-1112

NPI assigned

Sep 15, 2006

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Susan G McInville Jr.

Title

Business Service Representative

Phone

(843) 669-5162

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1346346954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1929A MOUNTAIN LAUREL CT",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295056053",
            "telephone_number": "843-669-5162",
            "fax_number": "843-667-4573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1929 MOUNTAIN LAUREL CT # A",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295056053",
            "telephone_number": "843-292-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTOR DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "MCINVILLE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "BUSINESS SERVICE REPRESENTATIVE",
        "authorized_official_telephone_number": "843-669-5162",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L00218",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walter James Evans, MD
• Ashley Marie Everhart, PHARM.D.
• Rona Barbara Ewart, R.D.
• Excell Monitoring
• Excellent Home Health Care
• Exodus Counseling and Consulting LLC
• Eyecare of Florence
• Eyemart Express LLC
• Michael Eyler, PTA
• Ifeyinwa Patricia Ezeudu, MD

• Clinical Medical Laboratory in Florence, SC
• Providers in Florence, SC by specialty
• Clinical Medical Laboratory in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.