| Albert Humphrey | |
|
4100 Main St Suite 101 Columbia SC 29203-5800 | |
| (803) 754-0006 | |
| (803) 735-1635 |
| Full Name | Albert Humphrey |
|---|---|
| Speciality | Internal Medicine |
| Location | 4100 Main St, Columbia, South Carolina |
| Authorized Official Name and Position | Albert Humphrey (OWNER) |
| Authorized Official Contact | 8037540006 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Albert Humphrey 4100 Main St Suite 101 Columbia SC 29203-5800 Ph: (803) 754-0006 | Albert Humphrey 4100 Main St Suite 101 Columbia SC 29203-5800 Ph: (803) 754-0006 |
| NPI Number | 1447435003 |
|---|---|
| Provider Enumeration Date | 01/02/2008 |
| Last Update Date | 12/18/2014 |
| Medicare PECOS PAC ID | 1658458310 |
|---|---|
| Medicare Enrollment ID | O20100604000914 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447435003 | NPI | - | NPPES |
| GP0304 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 8045 (South Carolina) | Primary |
| Provider Name | Albert Humphrey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770543621 PECOS PAC ID: 8820175581 Enrollment ID: I20100604000933 |
| Provider Name | Roxie H Chisholm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932502572 PECOS PAC ID: 3779807490 Enrollment ID: I20150128000906 |
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