| Grove Park Pharmacy Medical Clinic | |
|
1326 Grove Park Dr Orangeburg SC 29115 | |
| (803) 536-0007 | |
| (803) 536-2962 |
| Full Name | Grove Park Pharmacy Medical Clinic |
|---|---|
| Speciality | General Practice |
| Location | 1326 Grove Park Dr, Orangeburg, South Carolina |
| Authorized Official Name and Position | Charles Page Thompson (OWNER) |
| Authorized Official Contact | 8035360007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grove Park Pharmacy Medical Clinic Po Box 701 Orangeburg SC 29116-0701 Ph: (803) 536-0007 | Grove Park Pharmacy Medical Clinic 1326 Grove Park Dr Orangeburg SC 29115 Ph: (803) 536-0007 |
| NPI Number | 1306326640 |
|---|---|
| Provider Enumeration Date | 08/16/2018 |
| Last Update Date | 11/08/2018 |
| Medicare PECOS PAC ID | 4385704865 |
|---|---|
| Medicare Enrollment ID | O20190612000908 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306326640 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Tamara Till |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619504248 PECOS PAC ID: 5799116018 Enrollment ID: I20200520001697 |
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