| Kingstree Family Medicine Pa | |
|
512 Nelson Blvd Suite 200 Kingstree SC 29556-4027 | |
| (843) 355-5459 | |
| (843) 355-9704 |
| Full Name | Kingstree Family Medicine Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 512 Nelson Blvd, Kingstree, South Carolina |
| Authorized Official Name and Position | Raymond Keels Allen (PRESIDENT) |
| Authorized Official Contact | 8433555459 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kingstree Family Medicine Pa 512 Nelson Blvd Suite 200 Kingstree SC 29556-4027 Ph: (843) 355-5459 | Kingstree Family Medicine Pa 512 Nelson Blvd Suite 200 Kingstree SC 29556-4027 Ph: (843) 355-5459 |
| NPI Number | 1841286192 |
|---|---|
| Provider Enumeration Date | 09/22/2005 |
| Last Update Date | 06/03/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841286192 | NPI | - | NPPES |
| GP0509 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 11529 (South Carolina) | Primary |
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Mcleod Family Medicine Kingstree Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 512 Nelson Blvd Ste 200, Kingstree, SC 29556 Phone: 843-355-5459 Fax: 843-355-9704 | |
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