| |
4711 Sunset Blvd Lexington SC 29072-9151 | |
(803) 356-3609 | |
(803) 356-3941 |
Full Name | |
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Speciality | Family Medicine |
Location | 4711 Sunset Blvd, Lexington, South Carolina |
Authorized Official Name and Position | Darrell C Coven (DIRECTOR - BUSINESS DEV/FINANCE) |
Authorized Official Contact | 8032967301 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 402145 Atlanta GA 30384-2145 Ph: (803) 296-7306 | 4711 Sunset Blvd Lexington SC 29072-9151 Ph: (803) 356-3609 |
NPI Number | 1740446376 |
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Provider Enumeration Date | 08/04/2008 |
Last Update Date | 02/11/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740446376 | NPI | - | NPPES |
GP5017 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (South Carolina) | Primary |
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