| |
13649 Church St Williston SC 29853-5835 | |
(803) 266-0060 | |
(803) 266-0065 |
Full Name | |
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Speciality | Clinic/Center |
Location | 13649 Church St, Williston, South Carolina |
Authorized Official Name and Position | Ashley Barnes (CEO) |
Authorized Official Contact | 8036322533 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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86 Wren St Barnwell SC 29812-1529 Ph: (803) 259-5762 | 13649 Church St Williston SC 29853-5835 Ph: (803) 266-0060 |
NPI Number | 1922468826 |
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Provider Enumeration Date | 03/04/2016 |
Last Update Date | 01/11/2024 |
Medicare PECOS PAC ID | 4284530940 |
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Medicare Enrollment ID | O20160603001563 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922468826 | NPI | - | NPPES |
FQC#198 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |