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110a Springhall Dr Goose Creek SC 29445-5335 | |
(843) 973-8503 | |
(843) 990-5068 |
Full Name | |
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Speciality | Family Medicine |
Location | 110a Springhall Dr, Goose Creek, South Carolina |
Authorized Official Name and Position | Sara Elizabeth Maynor-hardy (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 8432258320 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 13955 Charleston SC 29422-3955 Ph: (843) 225-8320 | 110a Springhall Dr Goose Creek SC 29445-5335 Ph: (843) 973-8503 |
NPI Number | 1184169799 |
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Provider Enumeration Date | 01/05/2017 |
Last Update Date | 09/09/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1184169799 | NPI | - | NPPES |
GP6738 | Medicaid | SC | |
161924 | Medicaid | SC | |
A634 | Other | SC | MEDICARE PIN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 016192 (South Carolina) | Primary |
Primecare Family Practice Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 145 St James Ave, Goose Creek, SC 29445 Phone: 843-863-0777 Fax: 843-824-6119 | |
Palmetto Primary Care Physicians, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7 South Alliance Drive, Ste 201a, Goose Creek, SC 29445 Phone: 843-553-4383 Fax: 843-553-4384 |