Provider Demographics
NPI:1043440936
Name:DR. ELAINE JEFFERS, LLC
Entity type:Organization
Organization Name:DR. ELAINE JEFFERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-842-7575
Mailing Address - Street 1:14 NEW ORLEANS RD STE 4
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4777
Mailing Address - Country:US
Mailing Address - Phone:843-842-7575
Mailing Address - Fax:843-842-7676
Practice Address - Street 1:14 NEW ORLEANS RD STE 4
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29928-4777
Practice Address - Country:US
Practice Address - Phone:843-842-7575
Practice Address - Fax:843-842-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-25
Last Update Date:2009-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2233261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2233Medicaid
SCCH2233Medicaid