Excalibur Youth Services, Llc. | |
3683 S Industrial Dr Simpsonville SC 29681-3238 | |
(864) 836-7220 | |
Not Available |
Full Name | Excalibur Youth Services, Llc. |
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Speciality | Family Medicine |
Location | 3683 S Industrial Dr, Simpsonville, South Carolina |
Authorized Official Name and Position | John M Short (CEO) |
Authorized Official Contact | 8648367220 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Excalibur Youth Services, Llc. Po Box 968 Travelers Rest SC 29690-0968 Ph: (864) 836-7220 | Excalibur Youth Services, Llc. 3683 S Industrial Dr Simpsonville SC 29681-3238 Ph: (864) 836-7220 |
NPI Number | 1487174462 |
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Provider Enumeration Date | 06/21/2017 |
Last Update Date | 06/21/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1487174462 | NPI | - | NPPES |
1083852511 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (South Carolina) | Primary |
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