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225 S Herlong Ave Rock Hill SC 29732-2730 | |
(803) 325-7744 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Community Health |
Location | 225 S Herlong Ave, Rock Hill, South Carolina |
Authorized Official Name and Position | Ernest G. Brown (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 8033257744 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 28 Rock Hill SC 29731-6028 Ph: (803) 325-8742 | 225 S Herlong Ave Rock Hill SC 29732-2730 Ph: (803) 325-7744 |
NPI Number | 1164702114 |
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Provider Enumeration Date | 08/23/2011 |
Last Update Date | 08/23/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164702114 | NPI | - | NPPES |
CBP023 | Medicaid | SC | |
FQC025 | Medicaid | SC | |
421831 | Other | SD | MEDICARE ID |
4383 | Other | SC | MEDICARE PART B |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
Community Medicine Foundation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 205 Piedmont St, Rock Hill, SC 29730 Phone: 803-325-7744 | |