Full Name | |
---|---|
Speciality | Internal Medicine |
Location | 101 Main Street, Whitmire, South Carolina |
Authorized Official Name and Position | Pamela Vaughan (PRACTICE MANAGER) |
Authorized Official Contact | 8644272401 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
101 Main Street Whitmire SC 29178 Ph: (803) 694-3820 | 101 Main Street Whitmire SC 29178 Ph: (803) 694-3820 |
NPI Number | 1699914093 |
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Provider Enumeration Date | 02/10/2009 |
Last Update Date | 05/03/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699914093 | NPI | - | NPPES |
GP5095 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |