| |
200 E Hospital St Manning SC 29102-3160 | |
(803) 433-0439 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 200 E Hospital St, Manning, South Carolina |
Authorized Official Name and Position | Samuel Fulton Ervin (SR VICE PRESIDENT AND CFO) |
Authorized Official Contact | 8437772910 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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200 E Hospital St Manning SC 29102-3160 Ph: (803) 433-0439 | 200 E Hospital St Manning SC 29102-3160 Ph: (803) 433-0439 |
NPI Number | 1962851097 |
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Provider Enumeration Date | 06/09/2016 |
Last Update Date | 04/17/2020 |
Medicare PECOS PAC ID | 0840582656 |
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Medicare Enrollment ID | O20160808002187 |
Identifier | Type | State | Issuer |
---|---|---|---|
1962851097 | NPI | - | NPPES |
RHC242 | Medicaid | SC | |
87-3801 | Other | SC | MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Cypress Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1036 Professional Ct, Manning, SC 29102 Phone: 803-433-5220 Fax: 803-433-5221 | |
Hopehealth Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2155 Paxville Hwy, Manning, SC 29102 Phone: 803-433-4321 | |