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120 Darlington Drive Aiken SC 29803 | |
| (803) 641-1404 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 120 Darlington Drive, Aiken, South Carolina |
| Authorized Official Name and Position | Carolyn Emanuel- Mcclain (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8033807012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
120 Darlington Drive Aiken SC 29803 Ph: (803) 641-1404 | 120 Darlington Drive Aiken SC 29803 Ph: (803) 641-1404 |
| NPI Number | 1053362111 |
|---|---|
| Provider Enumeration Date | 05/13/2006 |
| Last Update Date | 05/08/2012 |
| Medicare PECOS PAC ID | 8527046010 |
|---|---|
| Medicare Enrollment ID | O20120215000776 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053362111 | NPI | - | NPPES |
| 046051 | Medicaid | SC | |
| FQC095 | Medicaid | SC | |
| RHC078 | Other | SC MEDICAID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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