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8063 Edmund Hwy Pelion SC 29123-9805 | |
(803) 894-3736 | |
(803) 894-5315 |
Full Name | |
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Speciality | Clinic/Center |
Location | 8063 Edmund Hwy, Pelion, 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 |
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Po Box 3788 Columbia SC 29230-3788 Ph: (803) 733-5969 | 8063 Edmund Hwy Pelion SC 29123-9805 Ph: (803) 894-3736 |
NPI Number | 1659657682 |
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Provider Enumeration Date | 10/21/2011 |
Last Update Date | 02/03/2022 |
Medicare PECOS PAC ID | 3274434220 |
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Medicare Enrollment ID | O20121019000326 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659657682 | NPI | - | NPPES |
FQC031 | Medicaid | SC | |
FQC118 | Medicaid | SC | |
CBP018 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |