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301 W Pine St Blacksburg SC 29702-1549 | |
(864) 839-4325 | |
(864) 839-9901 |
Full Name | |
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Speciality | Clinic/Center |
Location | 301 W Pine St, Blacksburg, South Carolina |
Authorized Official Name and Position | Daren Edward Carling (OWNER) |
Authorized Official Contact | 8648394325 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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301 W Pine St Blacksburg SC 29702-1549 Ph: (864) 839-4325 | 301 W Pine St Blacksburg SC 29702-1549 Ph: (864) 839-4325 |
NPI Number | 1730233172 |
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Provider Enumeration Date | 01/23/2007 |
Last Update Date | 02/25/2009 |
Medicare PECOS PAC ID | 2062442940 |
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Medicare Enrollment ID | O20050819000744 |
Identifier | Type | State | Issuer |
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1730233172 | NPI | - | NPPES |
RHC159 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 23503 (South Carolina) | Primary |