Full Name | |
---|---|
Speciality | Family Medicine |
Location | 22 Bozard 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 |
---|---|
22 Bozard St Manning SC 29102-2935 Ph: (803) 435-8828 | 22 Bozard St Manning SC 29102-2935 Ph: (803) 435-8828 |
NPI Number | 1497104525 |
---|---|
Provider Enumeration Date | 06/09/2016 |
Last Update Date | 02/25/2019 |
Medicare PECOS PAC ID | 0840582656 |
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Medicare Enrollment ID | O20160810001390 |
Identifier | Type | State | Issuer |
---|---|---|---|
1497104525 | NPI | - | NPPES |
42-3460 | Other | SC | MEDICARE |
RHC243 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (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 | |