| Broad River Wellness, Llc | |
|
4027 Woodlawn St Sharon SC 29742-8779 | |
| (803) 627-0220 | |
| Not Available |
| Full Name | Broad River Wellness, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4027 Woodlawn St, Sharon, South Carolina |
| Authorized Official Name and Position | Rebecca Baker (OWNER) |
| Authorized Official Contact | 8036585058 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broad River Wellness, Llc 4027 Woodlawn St Sharon SC 29742-8779 Ph: (803) 658-5058 | Broad River Wellness, Llc 4027 Woodlawn St Sharon SC 29742-8779 Ph: (803) 627-0220 |
| NPI Number | 1992454532 |
|---|---|
| Provider Enumeration Date | 03/21/2022 |
| Last Update Date | 06/17/2024 |
| Medicare PECOS PAC ID | 2567841281 |
|---|---|
| Medicare Enrollment ID | O20220627000153 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992454532 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Rebecca R Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457700304 PECOS PAC ID: 1557658184 Enrollment ID: I20160927000135 |
| Provider Name | Huyen Bui |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619514833 PECOS PAC ID: 3870923923 Enrollment ID: I20200414001312 |