|
| |
|
25 E Clark St Pinewood SC 29125-8989 | |
| (803) 774-4516 | |
| (803) 452-5712 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 25 E Clark St, Pinewood, South Carolina |
| Authorized Official Name and Position | Annie Brown Geddings (CEO) |
| Authorized Official Contact | 8037744500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 250 Sumter SC 29151-0250 Ph: (803) 774-4500 | 25 E Clark St Pinewood SC 29125-8989 Ph: (803) 774-4516 |
| NPI Number | 1811973068 |
|---|---|
| Provider Enumeration Date | 12/20/2005 |
| Last Update Date | 10/14/2019 |
| Medicare PECOS PAC ID | 3870575855 |
|---|---|
| Medicare Enrollment ID | O20050623000266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811973068 | NPI | - | NPPES |
| FQC048 | Medicaid | SC | |
| 372048 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Tandem Health Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 200 W. Clark St., Pinewood, SC 29125 Phone: 803-830-6184 Fax: 803-774-4626 |