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3032 E Highway 76 Mullins SC 29574-7396 | |
(843) 464-7111 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 3032 E Highway 76, Mullins, South Carolina |
Authorized Official Name and Position | Samuel Fulton Ervin (SR VP 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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Po Box 100567 Florence SC 29502-0567 Ph: () - | 3032 E Highway 76 Mullins SC 29574-7396 Ph: (843) 464-7111 |
NPI Number | 1710532486 |
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Provider Enumeration Date | 08/08/2019 |
Last Update Date | 10/04/2019 |
Medicare PECOS PAC ID | 7911228259 |
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Medicare Enrollment ID | O20190927003167 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710532486 | NPI | - | NPPES |
42-8927 | Other | SC | PTAN |
RHC169 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Medical University Hospital Authority Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 511 S Main St, Mullins, SC 29574 Phone: 843-464-8244 | |
Palmetto Medical Care Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1002 S Main St, Mullins, SC 29574 Phone: 843-245-0613 | |