| Sc Professional Services, Llc | |
|
1064 Gardner Rd Ste 215 Charleston SC 29407-1712 | |
| (843) 779-7718 | |
| (404) 920-3484 |
| Full Name | Sc Professional Services, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1064 Gardner Rd Ste 215, Charleston, South Carolina |
| Authorized Official Name and Position | Kassi Goodman (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 8437797718 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sc Professional Services, Llc 1064 Gardner Rd Ste 215 Charleston SC 29407-1712 Ph: (843) 779-7718 | Sc Professional Services, Llc 1064 Gardner Rd Ste 215 Charleston SC 29407-1712 Ph: (843) 779-7718 |
| NPI Number | 1447078233 |
|---|---|
| Provider Enumeration Date | 09/30/2024 |
| Last Update Date | 11/08/2024 |
| Certification Date | 11/08/2024 |
| Medicare PECOS PAC ID | 5991233397 |
|---|---|
| Medicare Enrollment ID | O20250114000030 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447078233 | NPI | - | NPPES |
| Provider Name | Suzanne M Echemendia Wirth |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962590778 PECOS PAC ID: 6800817610 Enrollment ID: I20130426000622 |
| Provider Name | Rhonda Lea Witt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487298584 PECOS PAC ID: 3779902770 Enrollment ID: I20210720001566 |
| Provider Name | Andrea Kathleen Rizzetto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073087441 PECOS PAC ID: 4183021900 Enrollment ID: I20210921003922 |
| Provider Name | Lauren R Parkman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699411272 PECOS PAC ID: 3971987330 Enrollment ID: I20220902000584 |
| Provider Name | Ashley C Royer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407699051 PECOS PAC ID: 8729526785 Enrollment ID: I20240821003103 |
| Provider Name | Jessica Ace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619704962 PECOS PAC ID: 5597293910 Enrollment ID: I20250114000636 |
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