| Carolinas Medical Alliance Inc | |
|
1590 Freedom Blvd Ste A Florence SC 29505-6071 | |
| (843) 679-4214 | |
| Not Available |
| Full Name | Carolinas Medical Alliance Inc |
|---|---|
| Speciality | General Practice |
| Location | 1590 Freedom Blvd, Florence, South Carolina |
| Authorized Official Name and Position | Debbie Brewer (DIRECTOR OF PROVIDER ENROLLMENT) |
| Authorized Official Contact | 6154657000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolinas Medical Alliance Inc 1590 Freedom Blvd Ste A Florence SC 29505-6071 Ph: (843) 679-4214 | Carolinas Medical Alliance Inc 1590 Freedom Blvd Ste A Florence SC 29505-6071 Ph: (843) 679-4214 |
| NPI Number | 1386602902 |
|---|---|
| Provider Enumeration Date | 05/03/2006 |
| Last Update Date | 08/28/2007 |
| Medicare PECOS PAC ID | 9739096769 |
|---|---|
| Medicare Enrollment ID | O20040601000354 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386602902 | NPI | - | NPPES |
| GP3796 | Medicaid | SC | |
| GP3747 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (South Carolina) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Charles E Stonerock |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1205860210 PECOS PAC ID: 8628072311 Enrollment ID: I20060912000276 |
| Provider Name | Russell Leon Mcelveen |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1275714735 PECOS PAC ID: 1951540343 Enrollment ID: I20141015000945 |
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