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1004 S Main St Mullins SC 29574-3920 | |
(843) 464-1201 | |
(843) 464-1219 |
Full Name | |
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Speciality | Family Medicine |
Location | 1004 S Main St, Mullins, South Carolina |
Authorized Official Name and Position | Wayne Hooks (CFO) |
Authorized Official Contact | 8434641201 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 151 Nichols SC 29581-0151 Ph: (843) 464-1201 | 1004 S Main St Mullins SC 29574-3920 Ph: (843) 464-1201 |
NPI Number | 1073518486 |
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Provider Enumeration Date | 06/14/2005 |
Last Update Date | 02/13/2008 |
Identifier | Type | State | Issuer |
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1073518486 | NPI | - | NPPES |
PA 8599 | Medicaid | SC | |
RHC 119 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 110597 (South Carolina) | Primary |
Medical University Hospital Authority Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 511 S Main St, Mullins, SC 29574 Phone: 843-464-8244 | |
Palmetto Medical Care Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1002 S Main St, Mullins, SC 29574 Phone: 843-245-0613 | |