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104 Fleetwood Drive Easley SC 29640 | |
(864) 859-3998 | |
(864) 855-1045 |
Full Name | |
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Speciality | Family Medicine |
Location | 104 Fleetwood Drive, Easley, South Carolina |
Authorized Official Name and Position | Kendall J Durham (FINANCIAL SERVICES REP-MANAGER) |
Authorized Official Contact | 8648555104 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 2089 Easley SC 29641-2089 Ph: (864) 855-5104 | 104 Fleetwood Drive Easley SC 29640 Ph: (864) 859-3998 |
NPI Number | 1265645352 |
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Provider Enumeration Date | 05/07/2007 |
Last Update Date | 11/18/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265645352 | NPI | - | NPPES |
DE1917 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Fleetwood Internal Medicine Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 109b Fleetwood Dr, Easley, SC 29640 Phone: 864-855-1036 Fax: 864-855-3318 | |