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945 E Main St Ste A Spartanburg SC 29302-2119 | |
| (864) 582-2411 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 945 E Main St Ste A, Spartanburg, South Carolina |
| Authorized Official Name and Position | Marlon Hunter (CEO) |
| Authorized Official Contact | 8645940190 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 5158 Spartanburg SC 29304-5158 Ph: (864) 582-2411 | 945 E Main St Ste A Spartanburg SC 29302-2119 Ph: (864) 582-2411 |
| NPI Number | 1457061087 |
|---|---|
| Provider Enumeration Date | 12/05/2022 |
| Last Update Date | 01/03/2025 |
| Certification Date | 01/03/2025 |
| Medicare PECOS PAC ID | 8022928001 |
|---|---|
| Medicare Enrollment ID | O20240613002781 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457061087 | NPI | - | NPPES |
| 1194710426 | Other | NPI |
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