| Pendleton Family Practice, Llc | |
|
101 Shirley St Pendleton SC 29670-1824 | |
| (864) 646-7522 | |
| (864) 646-3377 |
| Full Name | Pendleton Family Practice, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 101 Shirley St, Pendleton, South Carolina |
| Authorized Official Name and Position | Stacy Lee Smith (OWNER/PHYSICIAN) |
| Authorized Official Contact | 8646467522 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pendleton Family Practice, Llc Po Box 547 Pendleton SC 29670-0547 Ph: (864) 646-7522 | Pendleton Family Practice, Llc 101 Shirley St Pendleton SC 29670-1824 Ph: (864) 646-7522 |
| NPI Number | 1790705259 |
|---|---|
| Provider Enumeration Date | 07/20/2006 |
| Last Update Date | 08/07/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790705259 | NPI | - | NPPES |
| GP3375 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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Anmed Primary Care - Pendleton Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1005 Meehan Way, Pendleton, SC 29670 Phone: 864-646-7522 Fax: 864-646-3377 | |
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