| Advantage Integrated Medical | |
|
1926 S Lake Dr Lexington SC 29073-8282 | |
| (803) 462-5440 | |
| Not Available |
| Full Name | Advantage Integrated Medical |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 1926 S Lake Dr, Lexington, South Carolina |
| Authorized Official Name and Position | David Gooldy (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 8034625440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advantage Integrated Medical 1926 S Lake Dr Lexington SC 29073-8282 Ph: () - | Advantage Integrated Medical 1926 S Lake Dr Lexington SC 29073-8282 Ph: (803) 462-5440 |
| NPI Number | 1013669126 |
|---|---|
| Provider Enumeration Date | 01/20/2022 |
| Last Update Date | 01/20/2022 |
| Medicare PECOS PAC ID | 4981098449 |
|---|---|
| Medicare Enrollment ID | O20220225001182 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013669126 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Primary |
| Provider Name | Jon Kennon Peters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720320740 PECOS PAC ID: 2860626470 Enrollment ID: I20131015001627 |
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