Full Name | |
---|---|
Speciality | Internal Medicine |
Location | 166 Main St, Whitmire, South Carolina |
Authorized Official Name and Position | Kenneth Meinke (CFO) |
Authorized Official Contact | 8645606000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 743070 Atlanta GA 30374-3070 Ph: (864) 560-4304 | 166 Main St Whitmire SC 29178-1318 Ph: (864) 560-6563 |
NPI Number | 1699150995 |
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Provider Enumeration Date | 07/28/2015 |
Last Update Date | 12/14/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699150995 | NPI | - | NPPES |
GP6959 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (South Carolina) | Primary |