Depriest, Jack Legrand

Depriest, Jack Legrand is an individual health care provider with primary practice located at 1 Richland Medical Park Dr Ste 300 , Columbia SC 29203-6831. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Hospitalist, Allopathic & Osteopathic Physicians / Critical Care Medicine. Allopathic & Osteopathic Physicians / Critical Care Medicine is his primary health care specialty. Depriest, Jack Legrand can be contacted via phone (803) 545-5500.

Contact Information

Primary practice address
1 Richland Medical Park Dr Ste 300 Columbia SC 29203-6831
Phone: (803) 545-5500
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Hospitalist 208M00000X 23454 West Virginia
Allopathic & Osteopathic Physicians / Critical Care Medicine 207RC0200X 81661 South Carolina
Allopathic & Osteopathic Physicians / Critical Care Medicine 207RC0200X MD065996L Pennsylvania

Profile Details

NPI number 1881699957
LBN Legal business name Depriest, Jack Legrand
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2005
Last updated Jun 2nd, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881699957 NPPES
Pennsylvania MEDICAID 001699305
Pennsylvania MEDICAID 816610

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