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410 S Herlong Ave Suite 106 Rock Hill SC 29732-8349 | |
(803) 329-3899 | |
(803) 329-4377 |
Full Name | |
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Speciality | Internal Medicine |
Location | 410 S Herlong Ave, Rock Hill, South Carolina |
Authorized Official Name and Position | Robert Wozniak (PRESIDENT) |
Authorized Official Contact | 8033293899 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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410 S Herlong Ave Suite 106 Rock Hill SC 29732-8349 Ph: (803) 329-3899 | 410 S Herlong Ave Suite 106 Rock Hill SC 29732-8349 Ph: (803) 329-3899 |
NPI Number | 1255499950 |
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Provider Enumeration Date | 12/05/2006 |
Last Update Date | 10/19/2007 |
Medicare PECOS PAC ID | 5193638898 |
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Medicare Enrollment ID | O20031110000136 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255499950 | NPI | - | NPPES |
1942282470 | Other | SC | NPI INDIVIDUAL |
210195 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | 21019 (South Carolina) | Primary |
Provider Name | Robert Wozniak |
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Provider Type | Practitioner - Endocrinology |
Provider Identifiers | NPI Number: 1942282470 PECOS PAC ID: 0345153086 Enrollment ID: I20031111000264 |
Community Medicine Foundation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 205 Piedmont St, Rock Hill, SC 29730 Phone: 803-325-7744 | |