| |
108 Montgomery Drive Anderson SC 29621-3334 | |
(864) 225-5597 | |
(864) 225-5835 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 108 Montgomery Drive, Anderson, South Carolina |
Authorized Official Name and Position | Daniel A Mccollum (CEO) |
Authorized Official Contact | 8643432611 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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P.o. Box 484 Easley SC 29641-4848 Ph: (864) 855-1633 | 108 Montgomery Drive Anderson SC 29621-3334 Ph: (864) 225-5597 |
NPI Number | 1104157718 |
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Provider Enumeration Date | 01/21/2010 |
Last Update Date | 01/21/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104157718 | NPI | - | NPPES |
GP2763 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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