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1136 Kincaid Bridge Rd Ste. A Winnsboro SC 29180-7116 | |
(803) 635-1052 | |
(803) 712-9724 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1136 Kincaid Bridge Rd, Winnsboro, South Carolina |
Authorized Official Name and Position | Delgado Cantave (CEO) |
Authorized Official Contact | 8037335969 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 3788 Columbia SC 29230-3788 Ph: (803) 733-5969 | 1136 Kincaid Bridge Rd Ste. A Winnsboro SC 29180-7116 Ph: (803) 635-1052 |
NPI Number | 1003113168 |
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Provider Enumeration Date | 02/24/2011 |
Last Update Date | 02/03/2022 |
Medicare PECOS PAC ID | 3274434220 |
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Medicare Enrollment ID | O20120622000335 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003113168 | NPI | - | NPPES |
FQC031 | Medicaid | SC | |
FQC133 | Medicaid | SC | |
CBP018 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Fairfield Medical Associates, Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 880 West Moultrie St., Suite 200, Winnsboro, SC 29180 Phone: 803-635-6487 Fax: 803-635-6089 | |