Basic Information
Provider Information
NPI: 1245814599
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YUMEN
FirstName: ANNA
MiddleName: VICTORIA
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PRISMA HEALTH MEDICAL GROUP SURGERY CENTER
Address2: 2 MEDICAL PARK, STE 300
City: COLUMBIA
State: SC
PostalCode: 29203
CountryCode: US
TelephoneNumber: 8035455800
FaxNumber: 8039289492
Practice Location
Address1: PRISMA HEALTH MEDICAL GROUP SURGERY CENTER
Address2: 2 MEDICAL PARK, STE 300
City: COLUMBIA
State: SC
PostalCode: 29203
CountryCode: US
TelephoneNumber: 8035455800
FaxNumber: 8039289492
Other Information
ProviderEnumerationDate: 05/11/2021
LastUpdateDate: 05/11/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XLL85683SCY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


Home