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10278 Old Number Six Hwy Vance SC 29163-9342 | |
(803) 531-6900 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 10278 Old Number Six Hwy, Vance, South Carolina |
Authorized Official Name and Position | Stan Wardlaw (CEO) |
Authorized Official Contact | 8035316900 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3310 Magnolia St Orangeburg SC 29115-1466 Ph: (803) 531-6900 | 10278 Old Number Six Hwy Vance SC 29163-9342 Ph: (803) 531-6900 |
NPI Number | 1346444601 |
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Provider Enumeration Date | 06/12/2007 |
Last Update Date | 01/15/2025 |
Medicare PECOS PAC ID | 2860305075 |
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Medicare Enrollment ID | O20131108001489 |
Identifier | Type | State | Issuer |
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1346444601 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |