| Etas Clinic, P.c. | |
|
400 N Fant St Suite A Anderson SC 29621-5720 | |
| (864) 226-5260 | |
| (864) 226-5863 |
| Full Name | Etas Clinic, P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 400 N Fant St, Anderson, South Carolina |
| Authorized Official Name and Position | Ekong I. Eta (CEO) |
| Authorized Official Contact | 8642265260 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Etas Clinic, P.c. 400 N Fant St Suite A Anderson SC 29621-5720 Ph: (864) 226-5260 | Etas Clinic, P.c. 400 N Fant St Suite A Anderson SC 29621-5720 Ph: (864) 226-5260 |
| NPI Number | 1699724849 |
|---|---|
| Provider Enumeration Date | 05/07/2006 |
| Last Update Date | 12/04/2007 |
| Medicare PECOS PAC ID | 2567620099 |
|---|---|
| Medicare Enrollment ID | O20120229000713 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699724849 | NPI | - | NPPES |
| 215011 | Medicaid | SC | |
| GP2896 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 21501 (South Carolina) | Primary |
| Provider Name | Ekong Ito Eta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598945081 PECOS PAC ID: 6800821026 Enrollment ID: I20050927000842 |
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