| |
1619 Carolina Ave Orangeburg SC 29115-4939 | |
(803) 531-7474 | |
(803) 531-7457 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 1619 Carolina Ave, Orangeburg, South Carolina |
Authorized Official Name and Position | Liza M Porterfield (C F O) |
Authorized Official Contact | 8033954458 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1245 Orangeburg SC 29116-1245 Ph: (803) 395-4762 | 1619 Carolina Ave Orangeburg SC 29115-4939 Ph: (803) 531-7474 |
NPI Number | 1639475429 |
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Provider Enumeration Date | 01/27/2011 |
Last Update Date | 02/26/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639475429 | NPI | - | NPPES |
018 | Other | SC | BCBS |
018 | Other | SC | BLUECHOICE |
016 | Other | SC | TRICARE |
GP5343 | Medicaid | SC | |
CK8831 | Other | SC | RRMEDICARE |
RHC217 | Medicaid | SC | |
CN8991 | Other | SC | RRMEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (South Carolina) | Primary |
Orangeburg Primary Preventive & Occupational Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1620 Broughton Street, Orangeburg, SC 29115 Phone: 803-531-6030 Fax: 803-531-6056 | |
Palmetto Primary Care Physicians, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1205 Hutto St, Orangeburg, SC 29118 Phone: 803-531-3911 Fax: 803-531-2666 | |
Occ Pro Healthcare Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1555 Middleton St, Orangeburg, SC 29115 Phone: 803-308-7746 | |
Stefan Montgomery Md Family & Sports Medicine, Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2850 Pelham Ct, Orangeburg, SC 29118 Phone: 803-531-8500 | |
Gross Family Practice Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 970 Holly St, Orangeburg, SC 29115 Phone: 803-531-2722 Fax: 803-531-2743 | |