| Greenville Age Management Medical Institute, Llc | |
|
540 Old Howell Rd Greenville SC 29615-1969 | |
| (864) 365-0100 | |
| Not Available |
| Full Name | Greenville Age Management Medical Institute, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 540 Old Howell Rd, Greenville, South Carolina |
| Authorized Official Name and Position | Marcela Young (OWNER) |
| Authorized Official Contact | 8643650100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greenville Age Management Medical Institute, Llc 540 Old Howell Rd Greenville SC 29615-1969 Ph: () - | Greenville Age Management Medical Institute, Llc 540 Old Howell Rd Greenville SC 29615-1969 Ph: (864) 365-0100 |
| NPI Number | 1275963175 |
|---|---|
| Provider Enumeration Date | 11/14/2013 |
| Last Update Date | 11/14/2013 |
| Medicare PECOS PAC ID | 9638302904 |
|---|---|
| Medicare Enrollment ID | O20140513000416 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275963175 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 14183 (South Carolina) | Primary |
| Provider Name | Marcella V Young |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497880678 PECOS PAC ID: 1658431580 Enrollment ID: I20081121000104 |
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