Private Physician Group Llc | |
1698 Highway 160 W Ste 200 Fort Mill SC 29708-8034 | |
(516) 590-4475 | |
(803) 267-8229 |
Full Name | Private Physician Group Llc |
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Speciality | Family Medicine |
Location | 1698 Highway 160 W Ste 200, Fort Mill, South Carolina |
Authorized Official Name and Position | Catherine L. Ferrara (OWNER) |
Authorized Official Contact | 5165904475 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Private Physician Group Llc 22076 Preswick Dr Fort Mill SC 29707-6202 Ph: (516) 590-4475 | Private Physician Group Llc 1698 Highway 160 W Ste 200 Fort Mill SC 29708-8034 Ph: (516) 590-4475 |
NPI Number | 1639841323 |
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Provider Enumeration Date | 09/30/2021 |
Last Update Date | 09/30/2021 |
Medicare PECOS PAC ID | 9335530948 |
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Medicare Enrollment ID | O20211215000943 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639841323 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Catherine L Ferrara |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1386750206 PECOS PAC ID: 7315957339 Enrollment ID: I20180717004157 |
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