| Pediatrics Of Batesburg-leesville | |
|
120 W Church St Suite E Batesburg SC 29006-2107 | |
| (803) 532-2208 | |
| (803) 604-0207 |
| Full Name | Pediatrics Of Batesburg-leesville |
|---|---|
| Speciality | Clinic/Center |
| Location | 120 W Church St, Batesburg, South Carolina |
| Authorized Official Name and Position | Delgado Cantave (CEO) |
| Authorized Official Contact | 8037335969 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatrics Of Batesburg-leesville Po Box 3788 Columbia SC 29230-3788 Ph: (803) 733-5969 | Pediatrics Of Batesburg-leesville 120 W Church St Suite E Batesburg SC 29006-2107 Ph: (803) 532-2208 |
| NPI Number | 1710290762 |
|---|---|
| Provider Enumeration Date | 07/20/2010 |
| Last Update Date | 03/03/2022 |
| Medicare PECOS PAC ID | 3274434220 |
|---|---|
| Medicare Enrollment ID | O20121030000286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710290762 | NPI | - | NPPES |
| FQC031 | Medicaid | SC | |
| CBP018 | Medicaid | SC | |
| FQC143 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |