Provider Demographics
NPI:1285708966
Name:FLORENCE NEUROLOGICAL CLINIC, PA
Entity type:Organization
Organization Name:FLORENCE NEUROLOGICAL CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHELY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-665-4104
Mailing Address - Street 1:1929 MOUNTAIN LAUREL CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6053
Mailing Address - Country:US
Mailing Address - Phone:843-665-4104
Mailing Address - Fax:843-661-0160
Practice Address - Street 1:1929 MOUNTAIN LAUREL CT
Practice Address - Street 2:SUITE B
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6053
Practice Address - Country:US
Practice Address - Phone:843-665-4104
Practice Address - Fax:843-661-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC138282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD17950Medicare UPIN
SC1493Medicare ID - Type Unspecified
SCD05584Medicare UPIN