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133 E 1st North St Ste 9 Summerville SC 29483-6873 | |
(843) 266-1100 | |
(843) 266-1119 |
Full Name | |
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Speciality | Clinic/Center |
Location | 133 E 1st North St Ste 9, Summerville, South Carolina |
Authorized Official Name and Position | John Kerndl (CFO & SECRETARY) |
Authorized Official Contact | 9797046547 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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6840 Carothers Pkwy Ste 550 Franklin TN 37067-8002 Ph: (979) 704-6547 | 133 E 1st North St Ste 9 Summerville SC 29483-6873 Ph: (843) 266-1100 |
NPI Number | 1710623103 |
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Provider Enumeration Date | 05/09/2022 |
Last Update Date | 06/21/2024 |
Medicare PECOS PAC ID | 9032410881 |
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Medicare Enrollment ID | O20220902002408 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710623103 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Steven Barnett |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1134175557 PECOS PAC ID: 2860395621 Enrollment ID: I20040129000307 |
Provider Name | Donald T Hanna |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1689639072 PECOS PAC ID: 6901798701 Enrollment ID: I20040414001393 |
Provider Name | Thomas Bolt |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1639136377 PECOS PAC ID: 2365337326 Enrollment ID: I20061005000460 |
Provider Name | Keyonna Porter |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1891159794 PECOS PAC ID: 1951693068 Enrollment ID: I20160711001861 |
Provider Name | Natisha Capers-howard |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1790395101 PECOS PAC ID: 4981023553 Enrollment ID: I20200930003300 |
Provider Name | Jessica Mitchell Simpkins |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1699444000 PECOS PAC ID: 5890184535 Enrollment ID: I20211117003089 |
Provider Name | Natalie Webb |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1427787373 PECOS PAC ID: 7719361138 Enrollment ID: I20220903000332 |
1800doctorb Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5130 Wescott Blvd, Summerville, SC 29485 Phone: 843-486-2712 | |
Seaside Family Medicine, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1341 College Park Rd # A, Summerville, SC 29486 Phone: 843-400-0028 Fax: 843-790-8449 | |
Palmetto Primary Care Physicians,llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1101 Old Trolley Rd, Ste. 100, Summerville, SC 29485 Phone: 843-572-7727 Fax: 843-569-5881 | |
Palmetto Primary Care Physicians, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5500 Front St Ste 240, Summerville, SC 29486 Phone: 843-695-6071 |