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105 S Franklin Dr Florence SC 29501-4364 | |
(843) 617-3226 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 105 S Franklin Dr, Florence, South Carolina |
Authorized Official Name and Position | Tierra Nicole Widder (AUTHORIZED OFFICIAL) |
Authorized Official Contact | 8436173226 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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105 S Franklin Dr Florence SC 29501-4364 Ph: (843) 617-3226 | 105 S Franklin Dr Florence SC 29501-4364 Ph: (843) 617-3226 |
NPI Number | 1669989901 |
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Provider Enumeration Date | 01/09/2018 |
Last Update Date | 11/19/2018 |
Medicare PECOS PAC ID | 0345594958 |
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Medicare Enrollment ID | O20181119001511 |
Identifier | Type | State | Issuer |
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1669989901 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Almeda Graham |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1144279365 PECOS PAC ID: 6901190461 Enrollment ID: I20160805000526 |
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