Stacy, Jason John

Stacy, Jason John is an individual health care provider with primary practice located at 3209 Colonial Dr , Columbia SC 29203-6930. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Stacy, Jason John can be contacted via phone (803) 434-6113.

Contact Information

Primary practice address
3209 Colonial Dr Columbia SC 29203-6930
Phone: (803) 434-6113
Fax: (803) 434-7231
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 24051 South Carolina
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 24051 South Carolina

Profile Details

NPI number 1831164334
LBN Legal business name Stacy, Jason John
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 20th, 2006
Last updated Apr 2nd, 2010 - about 16 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 1831164334 NPPES
South Carolina Other 0534520001 MEDICARE DME
South Carolina MEDICAID 240518 MEDICARE DME

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