| Traditions Health Of Charleston | |
|
133 E 1st North St Ste 9 Summerville SC 29483-6873 | |
| (843) 266-1100 | |
| (843) 266-1119 |
| Full Name | Traditions Health Of Charleston |
|---|---|
| Speciality | Clinic/Center |
| Location | 133 E 1st North St Ste 9, Summerville, South Carolina |
| Authorized Official Name and Position | David R Klementz (PRESIDENT & CEO) |
| Authorized Official Contact | 9797046547 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Traditions Health Of Charleston 150 4th Ave N Ste 2300 Nashville TN 37219-2466 Ph: (979) 704-6547 | Traditions Health Of Charleston 133 E 1st North St Ste 9 Summerville SC 29483-6873 Ph: (843) 266-1100 |
| NPI Number | 1710623103 |
|---|---|
| Provider Enumeration Date | 05/09/2022 |
| Last Update Date | 09/07/2023 |
| Medicare PECOS PAC ID | 9032410881 |
|---|---|
| Medicare Enrollment ID | O20220902002408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710623103 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Steven Barnett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134175557 PECOS PAC ID: 2860395621 Enrollment ID: I20040129000307 |
| Provider Name | Donald T Hanna |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689639072 PECOS PAC ID: 6901798701 Enrollment ID: I20040414001393 |
| Provider Name | Thomas Bolt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639136377 PECOS PAC ID: 2365337326 Enrollment ID: I20061005000460 |
| Provider Name | Keyonna Porter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891159794 PECOS PAC ID: 1951693068 Enrollment ID: I20160711001861 |
| Provider Name | Natisha Capers-howard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790395101 PECOS PAC ID: 4981023553 Enrollment ID: I20200930003300 |
| Provider Name | Jessica Mitchell Simpkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699444000 PECOS PAC ID: 5890184535 Enrollment ID: I20211117003089 |
| Provider Name | Natalie Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427787373 PECOS PAC ID: 7719361138 Enrollment ID: I20220903000332 |
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