Matthew Walter Jaenicke
Rheumatology
1711 Saint Julian Pl
Columbia
, South Carolina 29204-2409
Matthew Walter Jaenicke
Rheumatology
1711 Saint Julian Pl
Columbia
, South Carolina 29204-2409
(803) 256-2480
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About
Features
Specialties
- Rheumatology
Languages spoken
- English
Location
First Address
- Matthew Walter Jaenicke
- 1711 Saint Julian Pl
- Columbia, SC
- Zip : 29204-2409
- Fax : (803) 256-2480
- Phone : (803) 779-0911
Second Address
- Matthew Walter Jaenicke
- 1711 Saint Julian Pl
- Columbia, SC
- Zip : 29204-2409
- Fax : (803) 256-2480
- Phone : (803) 779-0911
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207RR0500X | Rheumatology | 38299 | SC |
National Provider Identifier
| NPI | 1063892008 |
|---|---|
| Provider Name | Matthew Walter Jaenicke |
| First Address | Columbia, SC 29204-2409 |
| Second Address | Columbia, SC 29204-2409 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 04/06/2015 |
| Last Update Date | 12/11/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0000030538 | (05) | VT |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.