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35 Walnut St Charleston SC 29403-4514 | |
(843) 722-4112 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 35 Walnut St, Charleston, South Carolina |
Authorized Official Name and Position | Aretha Jones (CEO) |
Authorized Official Contact | 8437224112 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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51 Nassau St Charleston SC 29403-5513 Ph: (843) 722-4112 | 35 Walnut St Charleston SC 29403-4514 Ph: (843) 722-4112 |
NPI Number | 1982124301 |
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Provider Enumeration Date | 06/27/2017 |
Last Update Date | 06/27/2017 |
Medicare PECOS PAC ID | 9032215199 |
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Medicare Enrollment ID | O20171006002377 |
Identifier | Type | State | Issuer |
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1982124301 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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