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103 Main Street South Bethune SC 29009 | |
(866) 737-4031 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 103 Main Street South, Bethune, South Carolina |
Authorized Official Name and Position | Ernest J Wardlaw (CEO) |
Authorized Official Contact | 8433358291 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 366 Mc Bee SC 29101-0366 Ph: (803) 669-3461 | 103 Main Street South Bethune SC 29009 Ph: (866) 737-4031 |
NPI Number | 1083228779 |
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Provider Enumeration Date | 09/01/2020 |
Last Update Date | 09/29/2023 |
Medicare PECOS PAC ID | 8224949821 |
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Medicare Enrollment ID | O20210316001973 |
Identifier | Type | State | Issuer |
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1083228779 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |