| Medical Group Of Thecarolinas - Woundhealingservices-maryblackcampus | |
|
11 Doctors Park Dr Ste 200 Spartanburg SC 29307-1008 | |
| (864) 573-3634 | |
| (864) 573-3637 |
| Full Name | Medical Group Of Thecarolinas - Woundhealingservices-maryblackcampus |
|---|---|
| Speciality | Family Medicine |
| Location | 11 Doctors Park Dr Ste 200, 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 |
|---|---|
| Medical Group Of Thecarolinas - Woundhealingservices-maryblackcampus Po Box 743070 Atlanta GA 30374-3070 Ph: (864) 560-4304 | Medical Group Of Thecarolinas - Woundhealingservices-maryblackcampus 11 Doctors Park Dr Ste 200 Spartanburg SC 29307-1008 Ph: (864) 573-3634 |
| NPI Number | 1649735127 |
|---|---|
| Provider Enumeration Date | 02/08/2019 |
| Last Update Date | 12/16/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649735127 | NPI | - | NPPES |
| GP8899 | Medicaid | SC | |
| PG9978 | Medicaid | SC | |
| 5019 | Other | SC | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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