Woodlandway Family Practice | |
111 West Pine Grove Rd Fairplay SC 29643 | |
(864) 972-5720 | |
(864) 972-5724 |
Full Name | Woodlandway Family Practice |
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Speciality | Family Medicine |
Location | 111 West Pine Grove Rd, Fairplay, South Carolina |
Authorized Official Name and Position | Kenneth H. Becker (PRESIDENT) |
Authorized Official Contact | 8649725720 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Woodlandway Family Practice Po Box 98 Fair Play SC 29643-0098 Ph: (864) 972-5720 | Woodlandway Family Practice 111 West Pine Grove Rd Fairplay SC 29643 Ph: (864) 972-5720 |
NPI Number | 1891985982 |
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Provider Enumeration Date | 07/26/2007 |
Last Update Date | 07/26/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891985982 | NPI | - | NPPES |
235720 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 23572 (South Carolina) | Primary |