Amethyst Health, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

AMETHYST HEALTH, LLC

Practice address

1175 Grey Pine Dr
Blythewood, SC 29016-7320

Phone

(717) 880-3740

NPI assigned

Apr 8, 2020

Last updated

Apr 8, 2020By 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

Wachovia Chanta' Banks, DONPI 1487880126

Title

Family Medicine Physician

Phone

(717) 880-3740

Specialties & licenses 2

Addresses

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.

• Wachovia Chanta' Banks, D.O.

  • Family Medicine Physician
  • Blythewood, SC
  • NPI 1487880126
  NPD Authorized official

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

{
    "created_epoch": "1586304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586304000000",
    "number": "1407475676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 GREY PINE DR",
            "city": "BLYTHEWOOD",
            "state": "SC",
            "postal_code": "290167320",
            "telephone_number": "717-880-3740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 GREY PINE DR",
            "city": "BLYTHEWOOD",
            "state": "SC",
            "postal_code": "290167320",
            "telephone_number": "717-880-3740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMETHYST HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-08",
        "last_updated": "2020-04-08",
        "certification_date": "2020-04-08",
        "status": "A",
        "authorized_official_last_name": "BANKS",
        "authorized_official_first_name": "WACHOVIA",
        "authorized_official_middle_name": "CHANTA'",
        "authorized_official_title_or_position": "FAMILY MEDICINE PHYSICIAN",
        "authorized_official_telephone_number": "717-880-3740",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adore Living Excellence
• Advanced Family Eye Care, LLC
• All Health Medical Equipment & Supply
• Kathryn Kaiser Allen, RN, BSN
• Mary Sandra Alleyne-McMillan, MHS, LMSW
• Anchored in Love Home Care LLC
• Erica Patrese Anthony
• Apple Transport
• Franz Badmaev, PHARMACIST
• Wachovia Chanta' Banks, D.O.

• Primary Care Clinic/Center in Blythewood, SC
• Providers in Blythewood, SC by specialty
• Primary Care Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; 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.