Provider Demographics
NPI:1578392924
Name:RISE MEDICAL CHARLESTON LLC
Entity type:Organization
Organization Name:RISE MEDICAL CHARLESTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-232-1064
Mailing Address - Street 1:1010 RIVERSHORE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7976
Mailing Address - Country:US
Mailing Address - Phone:606-232-1064
Mailing Address - Fax:
Practice Address - Street 1:5500 FRONT ST STE 250
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-8140
Practice Address - Country:US
Practice Address - Phone:843-278-8474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site