NPIMap

Organization Active NPI

Anderson District 4

  • School Registered Nurse
  • Pendleton, SC
National Provider Identifier
1922345164
Registry record updated Jan 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
School Registered NurseTaxonomy code 163WS0200X
License
62308 Issued in SC
Legal business name
ANDERSON DISTRICT 4
Practice address
2850 Lebanon Rd
Pendleton, SC 29670-9482
Phone
(864) 403-2400
Fax
(864) 716-3654
NPI assigned
Jan 8, 2013
Last updated
Jan 8, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2013

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

Authorized official

Name
Mrs. Kristi Walters Martin, R.N.NPI 1790022705
Title
Registered Nurse
Phone
(864) 403-2400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Registered Nurse 163WS0200X 62308 SC Primary

Addresses

Primary practice location

2850 Lebanon Rd
Pendleton, SC 29670-9482

Mailing address

2850 Lebanon Rd
Pendleton, SC 29670-9482
Phone (864) 403-2400

Other identifiers 1

IdentifierTypeStateIssuer
SD0404MedicaidSC

National Provider Directory

National Provider Directory
Tax ID family
Anderson District 46 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2850 Lebanon Rd
Pendleton, SC 29670
Phone (864) 403-2400

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": "1357603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357603200000",
    "number": "1922345164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 LEBANON RD",
            "city": "PENDLETON",
            "state": "SC",
            "postal_code": "296709482",
            "telephone_number": "864-403-2400",
            "fax_number": "864-716-3654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 LEBANON RD",
            "city": "PENDLETON",
            "state": "SC",
            "postal_code": "296709482",
            "telephone_number": "864-403-2400",
            "fax_number": "864-716-3654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSON DISTRICT 4",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-08",
        "last_updated": "2013-01-08",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "WALTERS",
        "authorized_official_title_or_position": "REGISTERED NURSE",
        "authorized_official_telephone_number": "864-403-2400",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "SC",
            "license": "62308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0404",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pendleton, SC

Sources for this page

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