Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 37 Pinckney St, York, South Carolina |
Authorized Official Name and Position | Anita M. Case (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 8039099710 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
455 Lakeshore Pkwy Rock Hill SC 29730-4205 Ph: () - | 37 Pinckney St York SC 29745-1731 Ph: (803) 909-6363 |
NPI Number | 1124491188 |
---|---|
Provider Enumeration Date | 11/12/2015 |
Last Update Date | 09/23/2020 |
Medicare PECOS PAC ID | 9638101272 |
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Medicare Enrollment ID | O20160419000063 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124491188 | NPI | - | NPPES |
7103 | Other | SC | MEDICARE PART B GROUP # |
FQC191 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 42-1037 (South Carolina) | Primary |
Tri-county Pediatrics Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 815 E Liberty St, York, SC 29745 Phone: 803-329-2700 | |
Pmc Physician Network, L.l.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1795 Devinney Rd, York, SC 29745 Phone: 803-818-5995 Fax: 803-818-5985 | |