Jordan Arthur Dean Jr, MD | |
111 Omni Drive, Seneca, SC 29672-9448 | |
(864) 888-4222 | |
(864) 888-0023 |
Full Name | Jordan Arthur Dean Jr |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 111 Omni Drive, Seneca, South Carolina |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1700887189 | NPI | - | NPPES |
GP4697 | Medicaid | SC | |
102524 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 10252 (South Carolina) | Primary |
Entity Name | Prisma Health University Medical Group |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1568799955 PECOS PAC ID: 8325950983 Enrollment ID: O20040108000041 |
Mailing Address | Practice Location Address |
---|---|
Jordan Arthur Dean Jr, MD 1 Independence Pt, Suite 212, Greenville, SC 29615-4545 Ph: (864) 797-6306 | Jordan Arthur Dean Jr, MD 111 Omni Drive, Seneca, SC 29672-9448 Ph: (864) 888-4222 |
Antoinette Marie Bannister, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 111 Omni Drive, Seneca, SC 29672 Phone: 864-888-4222 Fax: 864-888-0023 | |
Tarina Marlene Mendes, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 207 Main St, Seneca, SC 29678 Phone: 864-882-2906 | |
Dr. Miranda Lynn Worster, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 298 Memorial Dr, Seneca, SC 29672 Phone: 864-885-7758 Fax: 864-885-7749 | |
Dr. Carey Molin Gully, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 457- B Hwy 123 Bypass, Seneca, SC 29678 Phone: 864-888-4464 Fax: 864-888-4462 | |
Frank A Stewart, D.O. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 15579 Wells Highway, Seneca, SC 29678 Phone: 864-882-7800 Fax: 864-882-5908 | |
Lorraine Ann Bruce, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 111 Omni Drive, Seneca, SC 29672 Phone: 864-882-4222 Fax: 864-888-0023 | |
Lisa A Ruohoniemi, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 10706 Clemson Blvd, Seneca, SC 29678 Phone: 864-888-3020 Fax: 864-888-8585 |