| |
2 Innovation Dr Greenville SC 29607-5261 | |
(864) 400-3600 | |
(864) 400-3621 |
Full Name | |
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Speciality | Clinic/center |
Location | 2 Innovation Dr, Greenville, South Carolina |
Authorized Official Name and Position | Raymond E Mcculloch (CONTROLLER) |
Authorized Official Contact | 8642824910 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8580 Magellan Pkwy Richmond VA 23227-1149 Ph: (804) 627-5462 | 2 Innovation Dr Greenville SC 29607-5261 Ph: (864) 400-3600 |
NPI Number | 1104052752 |
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Provider Enumeration Date | 06/09/2009 |
Last Update Date | 06/25/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104052752 | NPI | - | NPPES |
251425 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | HTL794 (South Carolina) | Primary |
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