Stauffer, Jack Allan

Stauffer, Jack Allan is an individual health care provider with primary practice located at 435 N Cedar St , Summerville SC 29483-6407. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Stauffer, Jack Allan can be contacted via phone (843) 873-1592.

Contact Information

Primary practice address
435 N Cedar St Summerville SC 29483-6407
Phone: (843) 873-1592
Fax: (843) 820-3373
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 629 South Carolina

Profile Details

NPI number 1396703740
LBN Legal business name Stauffer, Jack Allan
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 3rd, 2006
Last updated Aug 30th, 2016 - about 9 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 1396703740 NPPES
South Carolina Other P00851396 RR MEDICARE PTAN
South Carolina MEDICAID NP0021 RR MEDICARE PTAN

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