| Providence Family Medicine Dutchfork | |
|
110 Dutchman Blvd Irmo SC 29063-8330 | |
| (803) 732-8370 | |
| (803) 732-8373 |
| Full Name | Providence Family Medicine Dutchfork |
|---|---|
| Speciality | Family Medicine |
| Location | 110 Dutchman Blvd, Irmo, South Carolina |
| Authorized Official Name and Position | Kelly A Mowrer (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 2164722741 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Family Medicine Dutchfork Po Box 601964 Charlotte NC 28260-1964 Ph: (855) 477-2477 | Providence Family Medicine Dutchfork 110 Dutchman Blvd Irmo SC 29063-8330 Ph: (803) 732-8370 |
| NPI Number | 1790114197 |
|---|---|
| Provider Enumeration Date | 11/06/2013 |
| Last Update Date | 11/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790114197 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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