Provider Demographics
NPI:1902293251
Name:MED-ENROLL
Entity Type:Organization
Organization Name:MED-ENROLL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KERSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-819-0801
Mailing Address - Street 1:PO BOX 5599
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-5599
Mailing Address - Country:US
Mailing Address - Phone:843-819-0801
Mailing Address - Fax:
Practice Address - Street 1:1354 CELEBRATION BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5495
Practice Address - Country:US
Practice Address - Phone:843-819-0801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management