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1319 S Main St Mc Cormick SC 29835-7928 | |
(864) 852-3336 | |
(864) 852-3339 |
Full Name | |
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Speciality | Family Medicine |
Location | 1319 S Main St, Mc Cormick, South Carolina |
Authorized Official Name and Position | Lisa Y Gilmer (PRACTICE ADMINISTRATOR) |
Authorized Official Contact | 8649418121 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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219a North Mine Street Mccormick SC 29835 Ph: (864) 852-3336 | 1319 S Main St Mc Cormick SC 29835-7928 Ph: (864) 852-3336 |
NPI Number | 1063545119 |
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Provider Enumeration Date | 03/14/2007 |
Last Update Date | 06/07/2023 |
Medicare PECOS PAC ID | 5496707804 |
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Medicare Enrollment ID | O20090303000391 |
Identifier | Type | State | Issuer |
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1063545119 | NPI | - | NPPES |
FQC002 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |