| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1612 Chapin Road, Chapin, South Carolina |
| Authorized Official Name and Position | Melinda P Kruzner (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Contact | 8037912000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 896239 Charlotte NC 28289-6239 Ph: (803) 345-3414 | 1612 Chapin Road Chapin SC 29036 Ph: (803) 345-3414 |
| NPI Number | 1508885666 |
|---|---|
| Provider Enumeration Date | 07/19/2006 |
| Last Update Date | 09/25/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508885666 | NPI | - | NPPES |
| GP4070 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Palmetto Homecare Physicians, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 221 Massey Cir, Chapin, SC 29036 Phone: 803-391-2755 | |