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10911 N Jacob Smart Blvd D Ridgeland SC 29936-2729 | |
(843) 784-3101 | |
(843) 784-5313 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 10911 N Jacob Smart Blvd, Ridgeland, South Carolina |
Authorized Official Name and Position | Ron Groteluschen (CFO) |
Authorized Official Contact | 8437848076 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 741261 Atlanta GA 30374-1261 Ph: (843) 784-3101 | 10911 N Jacob Smart Blvd D Ridgeland SC 29936-2729 Ph: (843) 784-3101 |
NPI Number | 1124307509 |
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Provider Enumeration Date | 08/16/2011 |
Last Update Date | 03/22/2022 |
Identifier | Type | State | Issuer |
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1124307509 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Bennett Medical Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 10876a N Jacob Smart Blvd, Ridgeland, SC 29936 Phone: 843-694-7728 | |
Altea Medical South Carolina Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1516 Grays Hwy, Ridgeland, SC 29936 Phone: 843-726-5581 |