| Palm Grove Regional Health, Llc | |
|
415 Market St Cheraw SC 29520-2636 | |
| (843) 927-0173 | |
| Not Available |
| Full Name | Palm Grove Regional Health, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 415 Market St, Cheraw, South Carolina |
| Authorized Official Name and Position | Eric Morse Willoughby (CEO/PRESIDENT) |
| Authorized Official Contact | 5732029865 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Palm Grove Regional Health, Llc 248 Market St # 1553 Cheraw SC 29520-2428 Ph: (843) 927-0173 | Palm Grove Regional Health, Llc 415 Market St Cheraw SC 29520-2636 Ph: (843) 927-0173 |
| NPI Number | 1043084817 |
|---|---|
| Provider Enumeration Date | 11/13/2023 |
| Last Update Date | 11/16/2023 |
| Medicare PECOS PAC ID | 3577906171 |
|---|---|
| Medicare Enrollment ID | O20240212000797 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043084817 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Benjamin Wells Weston |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225419252 PECOS PAC ID: 3870890296 Enrollment ID: I20170524001451 |
| Provider Name | Eric M Willoughby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598802738 PECOS PAC ID: 0547151797 Enrollment ID: I20190418001859 |
| Provider Name | Paseo Shatelle Douglas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972155471 PECOS PAC ID: 7618204546 Enrollment ID: I20190814003298 |
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