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105 Liberty Blvd Liberty SC 29657-1641 | |
(864) 843-9213 | |
(864) 843-5634 |
Full Name | |
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Speciality | Clinic/Center |
Location | 105 Liberty Blvd, Liberty, South Carolina |
Authorized Official Name and Position | Michael Cunningham (CEO) |
Authorized Official Contact | 8648981133 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 100174 Columbia SC 29202-3174 Ph: (864) 897-8286 | 105 Liberty Blvd Liberty SC 29657-1641 Ph: (864) 843-9213 |
NPI Number | 1902224876 |
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Provider Enumeration Date | 03/28/2014 |
Last Update Date | 06/21/2023 |
Medicare PECOS PAC ID | 8123930666 |
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Medicare Enrollment ID | O20170420002725 |
Identifier | Type | State | Issuer |
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1902224876 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Liberty Family Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 W Front St, Liberty, SC 29657 Phone: 864-843-5605 Fax: 864-843-0996 | |