| Midlands Neurobehavioral Services, Llc | |
|
160 Medical Cir Ste E West Columbia SC 29169-3639 | |
| (803) 708-9638 | |
| (888) 352-7678 |
| Full Name | Midlands Neurobehavioral Services, Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 160 Medical Cir Ste E, West Columbia, South Carolina |
| Authorized Official Name and Position | Shawna Blake Kirby (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8037089638 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midlands Neurobehavioral Services, Llc 160 Medical Cir Ste E West Columbia SC 29169-3639 Ph: (803) 708-9638 | Midlands Neurobehavioral Services, Llc 160 Medical Cir Ste E West Columbia SC 29169-3639 Ph: (803) 708-9638 |
| NPI Number | 1447709431 |
|---|---|
| Provider Enumeration Date | 10/02/2016 |
| Last Update Date | 05/03/2019 |
| Medicare PECOS PAC ID | 6901173228 |
|---|---|
| Medicare Enrollment ID | O20170517000279 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447709431 | NPI | - | NPPES |
| PS0613 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 1251 (South Carolina) | Primary |
| 103T00000X | Psychologist | 1251 (South Carolina) | Secondary |
| Provider Name | Shawna Kirby |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174686356 PECOS PAC ID: 7719254036 Enrollment ID: I20170517000533 |
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