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:
Health care specialties
| Specialty | Code | License # | 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 5 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1881699957 | NPPES |
| Pennsylvania | MEDICAID | 001699305 | |
| Pennsylvania | MEDICAID | 816610 |
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