Charleston Geriatrics And Post - Acute Care Llc | |
930 Tall Pine Rd Mount Pleasant SC 29464-2910 | |
(843) 209-1454 | |
Not Available |
Full Name | Charleston Geriatrics And Post - Acute Care Llc |
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Speciality | Family Medicine |
Location | 930 Tall Pine Rd, Mount Pleasant, South Carolina |
Authorized Official Name and Position | John E Kleckley (OWNER) |
Authorized Official Contact | 8432091454 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Charleston Geriatrics And Post - Acute Care Llc 930 Tall Pine Rd Mount Pleasant SC 29464-2910 Ph: () - | Charleston Geriatrics And Post - Acute Care Llc 930 Tall Pine Rd Mount Pleasant SC 29464-2910 Ph: (843) 209-1454 |
NPI Number | 1487031001 |
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Provider Enumeration Date | 05/04/2015 |
Last Update Date | 05/04/2015 |
Medicare PECOS PAC ID | 0244551976 |
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Medicare Enrollment ID | O20150608000350 |
Identifier | Type | State | Issuer |
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1487031001 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207QG0300X | Family Medicine - Geriatric Medicine | 29749 (South Carolina) | Primary |
Provider Name | John Edgar Kleckley |
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Provider Type | Practitioner - Geriatric Medicine |
Provider Identifiers | NPI Number: 1356544100 PECOS PAC ID: 0840385290 Enrollment ID: I20071001000637 |
Provider Name | Jody K Eblen |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578876553 PECOS PAC ID: 7911196019 Enrollment ID: I20110105000303 |
Provider Name | Elizabeth A Connor |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639508997 PECOS PAC ID: 5698902583 Enrollment ID: I20131223000264 |
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