| Gross Family Practice Llc | |
|
970 Holly St Orangeburg SC 29115-4930 | |
| (803) 531-2722 | |
| (803) 531-2743 |
| Full Name | Gross Family Practice Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 970 Holly St, Orangeburg, South Carolina |
| Authorized Official Name and Position | Rachael E Gross (OWNER/PHYSICIAN) |
| Authorized Official Contact | 8035312722 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gross Family Practice Llc Po Box 1442 Orangeburg SC 29116-1442 Ph: (803) 531-2722 | Gross Family Practice Llc 970 Holly St Orangeburg SC 29115-4930 Ph: (803) 531-2722 |
| NPI Number | 1417174806 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 04/21/2009 |
| Medicare PECOS PAC ID | 9234237231 |
|---|---|
| Medicare Enrollment ID | O20070613000842 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417174806 | NPI | - | NPPES |
| T00617 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Rachael E Gross |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467438853 PECOS PAC ID: 2567491582 Enrollment ID: I20050810000719 |
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