Waterway Primary Care,llc | |
3600 Sea Mountain Hwy Little River SC 29566-8161 | |
(843) 399-4848 | |
Not Available |
Full Name | Waterway Primary Care,llc |
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Speciality | Family Medicine |
Location | 3600 Sea Mountain Hwy, Little River, South Carolina |
Authorized Official Name and Position | Robert Ali Faile (AUTHORIZED OFFICIAL) |
Authorized Official Contact | 8438567924 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Waterway Primary Care,llc 3600 Sea Mountain Hwy Little River SC 29566-8161 Ph: (843) 399-4848 | Waterway Primary Care,llc 3600 Sea Mountain Hwy Little River SC 29566-8161 Ph: (843) 399-4848 |
NPI Number | 1295165579 |
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Provider Enumeration Date | 11/22/2013 |
Last Update Date | 11/25/2013 |
Medicare PECOS PAC ID | 4789807231 |
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Medicare Enrollment ID | O20140725001768 |
Identifier | Type | State | Issuer |
---|---|---|---|
1295165579 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Chris Boggs |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1326068362 PECOS PAC ID: 4082674015 Enrollment ID: I20041014000457 |
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