Provider Demographics
NPI:1356109664
Name:ABOVE AND BEYOND HEALTHCARE
Entity type:Organization
Organization Name:ABOVE AND BEYOND HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTAI
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:864-377-5026
Mailing Address - Street 1:140 KINKADE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-9077
Mailing Address - Country:US
Mailing Address - Phone:864-377-5026
Mailing Address - Fax:
Practice Address - Street 1:924 BYPASS 25 NE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-2900
Practice Address - Country:US
Practice Address - Phone:864-377-5026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty