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5225 Highway 165 Hollywood SC 29449-6144 | |
(843) 889-2272 | |
(843) 889-2274 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 5225 Highway 165, Hollywood, South Carolina |
Authorized Official Name and Position | Aretha R Jones (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 8437224112 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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51 Nassau St Charleston SC 29403-5513 Ph: (843) 722-4112 | 5225 Highway 165 Hollywood SC 29449-6144 Ph: (843) 889-2272 |
NPI Number | 1417282153 |
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Provider Enumeration Date | 10/14/2009 |
Last Update Date | 10/28/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1417282153 | NPI | - | NPPES |
FQC075 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Renovo Medical Consulting Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4770 Stono Links Dr, Hollywood, SC 29449 Phone: 615-714-6035 | |