Active NPI
Odell Samuel Jr.
- Nurse's Aide
- Columbia, SC
National Provider Identifier
1417347287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 166564E
- Practice address
- 6439 Garners Ferry Rd
Psychiatric Building 106
Columbia, SC 29209-1638 - Phone
- (803) 776-4000
- Fax
- (803) 695-6795
- NPI assigned
- Jan 30, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 166564E | SC | Primary |
Addresses
Primary practice location
6439 Garners Ferry Rd
Psychiatric Building 106
Columbia, SC 29209-1638
Mailing address
6439 Garners Ferry Rd
Psychiatric Building 106
Columbia, SC 29209-1638
Phone (803) 776-4000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 166564E | SC | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422576000000",
"number": "1417347287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6439 GARNERS FERRY RD",
"address_2": "PSYCHIATRIC BUILDING 106",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292091638",
"telephone_number": "803-776-4000",
"fax_number": "803-695-6795"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6439 GARNERS FERRY RD",
"address_2": "PSYCHIATRIC BUILDING 106",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292091638",
"telephone_number": "803-776-4000",
"fax_number": "803-695-6795"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUEL",
"first_name": "ODELL",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-01-30",
"last_updated": "2015-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "SC",
"license": "166564E",
"primary": true
}
],
"identifiers": [],
"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 Jan 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.