| Carolina Medical Associates | |
|
1787 Allendale Fairfax Hwy Fairfax SC 29827-9133 | |
| (803) 632-3311 | |
| (803) 632-3415 |
| Full Name | Carolina Medical Associates |
|---|---|
| Speciality | Family Medicine |
| Location | 1787 Allendale Fairfax Hwy, Fairfax, South Carolina |
| Authorized Official Name and Position | Ken Hiatt (ADMINISTRATOR) |
| Authorized Official Contact | 8036323311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolina Medical Associates Po Box 218 Fairfax SC 29827-0218 Ph: (803) 632-3311 | Carolina Medical Associates 1787 Allendale Fairfax Hwy Fairfax SC 29827-9133 Ph: (803) 632-3311 |
| NPI Number | 1730280561 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 05/14/2013 |
| Medicare PECOS PAC ID | 2567371610 |
|---|---|
| Medicare Enrollment ID | O20040304000896 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730280561 | NPI | - | NPPES |
| 20061068 | Other | SC | SELECT HEALTH |
| GP2791 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | HTL-041 (South Carolina) | Primary |
| Provider Name | Brian Richard Port |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336133602 PECOS PAC ID: 0143395087 Enrollment ID: I20170315000863 |
| Provider Name | Nancy Taylor Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184213134 PECOS PAC ID: 4587055611 Enrollment ID: I20211229000539 |
Carolina Medical Associates Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1787 Allendale Fairfax Highway, Fairfax, SC 29827 Phone: 803-632-3421 Fax: 803-632-2410 | |
Low Country Health Care System, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 333 Revoluntionary Trail, Fairfax, SC 29827 Phone: 803-632-2533 Fax: 803-632-2451 |