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4631 Savannah Highway North SC 29112-8180 | |
(803) 247-2428 | |
(803) 247-2650 |
Full Name | |
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Speciality | Family Medicine |
Location | 4631 Savannah Highway, North, South Carolina |
Authorized Official Name and Position | Liza 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 | 4631 Savannah Highway North SC 29112-8180 Ph: (803) 247-2428 |
NPI Number | 1841595667 |
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Provider Enumeration Date | 01/26/2011 |
Last Update Date | 09/28/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1841595667 | NPI | - | NPPES |
009 | Other | SC | BCBS |
009 | Other | SC | TRICARE |
CN8991 | Other | SC | RRMEDICARE |
GP44779 | Medicaid | SC | |
42-3881 | Other | SC | RHC MEDICAID |
CK8831 | Other | SC | RRMEDICARE |
009 | Other | SC | BLUECHOICE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
261QR1300X | Clinic/center - Rural Health | (South Carolina) | Secondary |