Provider Demographics
NPI:1386986859
Name:EHEALTH MEDICAL SYSTEMS
Entity type:Organization
Organization Name:EHEALTH MEDICAL SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-306-6105
Mailing Address - Street 1:200 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:SC
Mailing Address - Zip Code:29525-3001
Mailing Address - Country:US
Mailing Address - Phone:843-606-6515
Mailing Address - Fax:843-306-6035
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:SC
Practice Address - Zip Code:29525
Practice Address - Country:US
Practice Address - Phone:843-606-6515
Practice Address - Fax:843-306-6035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No333300000XSuppliersEmergency Response System CompaniesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP8546Medicaid