| Full Name | |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 109 Omni Dr, Seneca, South Carolina |
| Authorized Official Name and Position | Matthew G Hedtke (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8648857989 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
301 Memorial Dr Ste G Seneca SC 29672-9445 Ph: (864) 885-7989 | 109 Omni Dr Seneca SC 29672-9448 Ph: (864) 882-6141 |
| NPI Number | 1831375856 |
|---|---|
| Provider Enumeration Date | 01/22/2008 |
| Last Update Date | 01/22/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831375856 | NPI | - | NPPES |
| GP4697 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (South Carolina) | Primary |
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