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212 E Marion St Kershaw SC 29067-1442 | |
| (803) 465-3608 | |
| (803) 514-5740 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 212 E Marion St, Kershaw, South Carolina |
| Authorized Official Name and Position | Randall Stewart Barre (CEO) |
| Authorized Official Contact | 8034653608 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
212 E Marion St Kershaw SC 29067-1442 Ph: (803) 465-3608 | 212 E Marion St Kershaw SC 29067-1442 Ph: (803) 465-3608 |
| NPI Number | 1336403807 |
|---|---|
| Provider Enumeration Date | 06/29/2012 |
| Last Update Date | 02/16/2023 |
| Medicare PECOS PAC ID | 4789766932 |
|---|---|
| Medicare Enrollment ID | O20111219000365 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336403807 | NPI | - | NPPES |
| FQC140 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Sentinel Health Partners, Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 216 E Marion St, Kershaw, SC 29067 Phone: 803-475-3475 Fax: 803-475-5360 | |
Sandhills Medical Foundation, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 205 W Marion St, Kershaw, SC 29067 Phone: 803-475-4701 Fax: 803-475-4712 | |
Kershaw Family Medicine Associates Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 216 E Marion St, Kershaw, SC 29067 Phone: 803-475-3475 Fax: 803-475-5360 | |
Lancaster Clinic Corp Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 206 S Matson St, Kershaw, SC 29067 Phone: 803-475-1156 Fax: 803-475-1128 |