| Truesdale Medical Center Llc | |
|
5064 Rivers Ave North Charleston SC 29406-6304 | |
| (843) 266-3870 | |
| (843) 225-7541 |
| Full Name | Truesdale Medical Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5064 Rivers Ave, North Charleston, South Carolina |
| Authorized Official Name and Position | Bradley D. Childs (CEO) |
| Authorized Official Contact | 8437472273 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Truesdale Medical Center Llc 5064 Rivers Ave North Charleston SC 29406-6304 Ph: (843) 266-3870 | Truesdale Medical Center Llc 5064 Rivers Ave North Charleston SC 29406-6304 Ph: (843) 266-3870 |
| NPI Number | 1336627371 |
|---|---|
| Provider Enumeration Date | 08/01/2018 |
| Last Update Date | 09/19/2023 |
| Medicare PECOS PAC ID | 0042557951 |
|---|---|
| Medicare Enrollment ID | O20190131000993 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336627371 | NPI | - | NPPES |
| GP8664 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 18613 (South Carolina) | Primary |
| 207RI0200X | Internal Medicine - Infectious Disease | 18613 (South Carolina) | Secondary |
| Provider Name | William Dana Largen |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1336435205 PECOS PAC ID: 0840411740 Enrollment ID: I20160602000980 |
| Provider Name | Heather A Urie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295053486 PECOS PAC ID: 0840473575 Enrollment ID: I20161012000276 |
| Provider Name | Trevor Shane Gabel-baird |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164101531 PECOS PAC ID: 6305280835 Enrollment ID: I20240222003743 |
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