| |
411 E Main St Andrews SC 29510-4011 | |
(843) 264-1223 | |
(843) 264-1227 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 411 E Main St, Andrews, South Carolina |
Authorized Official Name and Position | Sandra D Gilliard (CEO) |
Authorized Official Contact | 8439907993 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 608 Mc Clellanville SC 29458-0608 Ph: (843) 887-3274 | 411 E Main St Andrews SC 29510-4011 Ph: (843) 264-1223 |
NPI Number | 1538766712 |
---|---|
Provider Enumeration Date | 10/01/2020 |
Last Update Date | 06/22/2022 |
Medicare PECOS PAC ID | 1658280334 |
---|---|
Medicare Enrollment ID | O20201113002827 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538766712 | NPI | - | NPPES |
048430 | Other | CHC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |