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101 Professional Park Gaffney SC 29340-2319 | |
(864) 489-1446 | |
(864) 489-4909 |
Full Name | |
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Speciality | Family Medicine |
Location | 101 Professional Park, Gaffney, South Carolina |
Authorized Official Name and Position | Alfred Randall Moss (PRESIDENT) |
Authorized Official Contact | 8644891446 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Post Office Box 1375 Gaffney SC 29342-1375 Ph: (864) 489-1446 | 101 Professional Park Gaffney SC 29340-2319 Ph: (864) 489-1446 |
NPI Number | 1063697894 |
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Provider Enumeration Date | 12/28/2007 |
Last Update Date | 05/10/2013 |
Medicare PECOS PAC ID | 3173436052 |
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Medicare Enrollment ID | O20031107000187 |
Identifier | Type | State | Issuer |
---|---|---|---|
1063697894 | NPI | - | NPPES |
PC3331 | Medicaid | SC | |
6737300001 | Other | SC | PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207QA0505X | Family Medicine - Adult Medicine | 009903 (South Carolina) | Primary |
Provider Name | Barbara C Ray |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1225095243 PECOS PAC ID: 0547228843 Enrollment ID: I20050103000400 |
Provider Name | Alfred R Moss |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1245294107 PECOS PAC ID: 6901718105 Enrollment ID: I20050111000411 |
Provider Name | Gina Yost |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942626502 PECOS PAC ID: 6709006075 Enrollment ID: I20141008002325 |
Provider Name | Susan J Fenderson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679981831 PECOS PAC ID: 6103142435 Enrollment ID: I20150304002259 |
Provider Name | Tina L Green |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013476506 PECOS PAC ID: 0941625974 Enrollment ID: I20200806003777 |
Provider Name | Jessica M Mccain |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528719747 PECOS PAC ID: 5597158998 Enrollment ID: I20220208000680 |
Cherokee Community Care, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1307 N Logan St, Gaffney, SC 29341 Phone: 864-488-1333 | |