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2191 Southport Rd Spartanburg SC 29306-6257 | |
(864) 216-4840 | |
(864) 583-5485 |
Full Name | |
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Speciality | Family Medicine |
Location | 2191 Southport Rd, Spartanburg, South Carolina |
Authorized Official Name and Position | Kenneth J Meinke (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 8645606103 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 743070 Atlanta GA 30374-3070 Ph: (864) 560-4304 | 2191 Southport Rd Spartanburg SC 29306-6257 Ph: (864) 216-4840 |
NPI Number | 1821567017 |
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Provider Enumeration Date | 11/16/2018 |
Last Update Date | 03/14/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1821567017 | NPI | - | NPPES |
GP8769 | Medicaid | SC | |
6084 | Other | SC | MEDICARE PIN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Academic Primary Care Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 410 Magnolia St, Spartanburg, SC 29303 Phone: 540-443-7180 | |