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4645 Augusta Rd Beech Island SC 29842-7265 | |
(803) 539-9283 | |
(803) 593-0607 |
Full Name | |
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Speciality | Clinic/Center |
Location | 4645 Augusta Rd, Beech Island, South Carolina |
Authorized Official Name and Position | Carolyn Emanuel-mcclain (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 8033807012 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 277 Clearwater SC 29822-0277 Ph: (803) 593-9283 | 4645 Augusta Rd Beech Island SC 29842-7265 Ph: (803) 539-9283 |
NPI Number | 1790846608 |
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Provider Enumeration Date | 12/13/2006 |
Last Update Date | 10/26/2016 |
Medicare PECOS PAC ID | 8527046010 |
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Medicare Enrollment ID | O20100312000306 |
Identifier | Type | State | Issuer |
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1790846608 | NPI | - | NPPES |
FQC007 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (South Carolina) | Primary |