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725 Harry C Raysor Dr St Matthews SC 29135-8403 | |
| (803) 874-3902 | |
| (803) 874-3905 |
| Full Name | |
|---|---|
| Speciality | Clinical Medical Laboratory |
| Location | 725 Harry C Raysor Dr, St Matthews, South Carolina |
| Authorized Official Name and Position | Terrell L Stone (OWNER) |
| Authorized Official Contact | 8038743902 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 638 St Matthews SC 29135-0638 Ph: (803) 874-3902 | 725 Harry C Raysor Dr St Matthews SC 29135-8403 Ph: (803) 874-3902 |
| NPI Number | 1790759520 |
|---|---|
| Provider Enumeration Date | 02/16/2006 |
| Last Update Date | 06/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790759520 | NPI | - | NPPES |
| GP0753 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 13583 (South Carolina) | Secondary |
| 291U00000X | Clinical Medical Laboratory | 42D0916819 (South Carolina) | Primary |
Musc Community Physicians Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 651a Harry C Raysor Dr, St Matthews, SC 29135 Phone: 843-792-1414 | |
Calhoun County High School Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 150 Saints Ave, St Matthews, SC 29135 Phone: 803-874-3071 | |
Ohio Valley Physicians Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2827 Old Belleville Rd, St Matthews, SC 29135 Phone: 888-221-1826 | |