| Gross Family Practice Llc | |
|
970 Holly St Orangeburg SC 29115-4930 | |
| (803) 531-2722 | |
| (803) 531-2743 |
| Full Name | Gross Family Practice Llc |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 970 Holly St, Orangeburg, South Carolina |
| Authorized Official Name and Position | Verdell F Haygood (OFFICE MANAGER) |
| Authorized Official Contact | 8035312722 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gross Family Practice Llc 970 Holly St Orangeburg SC 29115-4930 Ph: (803) 531-2722 | Gross Family Practice Llc 970 Holly St Orangeburg SC 29115-4930 Ph: (803) 531-2722 |
| NPI Number | 1083961114 |
|---|---|
| Provider Enumeration Date | 08/08/2012 |
| Last Update Date | 09/21/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083961114 | NPI | - | NPPES |
| H410155677 | Other | SC | MEDICARE ID |
| T00617 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0646 (South Carolina) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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