Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 776 2nd St E, Estill, South Carolina |
Authorized Official Name and Position | Roland J Gardner (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 8439877400 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
721 N Okatie Hwy # 170 Ridgeland SC 29936-8276 Ph: (843) 987-7400 | 776 2nd St E Estill SC 29918-4926 Ph: (803) 625-2548 |
NPI Number | 1598019341 |
---|---|
Provider Enumeration Date | 11/01/2012 |
Last Update Date | 08/08/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1598019341 | NPI | - | NPPES |
FQC101 | Medicaid | SC |