| 5 Star Family Medicine | |
|
7611 Highway 76 Suite C Pendleton SC 29670-9162 | |
| (864) 546-5570 | |
| (864) 546-5571 |
| Full Name | 5 Star Family Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 7611 Highway 76, Pendleton, South Carolina |
| Authorized Official Name and Position | Mark D Walsh (M.D. AND CEO) |
| Authorized Official Contact | 8646530163 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 5 Star Family Medicine 7611 Highway 76 Suite C Pendleton SC 29670-9162 Ph: (864) 546-5570 | 5 Star Family Medicine 7611 Highway 76 Suite C Pendleton SC 29670-9162 Ph: (864) 546-5570 |
| NPI Number | 1912329889 |
|---|---|
| Provider Enumeration Date | 01/13/2014 |
| Last Update Date | 01/13/2014 |
| Medicare PECOS PAC ID | 1850517145 |
|---|---|
| Medicare Enrollment ID | O20140722002397 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912329889 | NPI | - | NPPES |
| 20774 | Other | SC | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (South Carolina) | Primary |
| Provider Name | Mark D Walsh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265473813 PECOS PAC ID: 4981628849 Enrollment ID: I20060118000416 |
| Provider Name | Charlotte A G Branyon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477873487 PECOS PAC ID: 8820270945 Enrollment ID: I20110310000971 |
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