| Dr Temisan L Etikerentse, MD | |
|
110 Executive Pkwy, Moncks Corner, SC 29461-3930 | |
| (843) 899-9099 | |
| (843) 899-9091 |
| Full Name | Dr Temisan L Etikerentse |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine |
| Experience | 35 Years |
| Location | 110 Executive Pkwy, Moncks Corner, South Carolina |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710986757 | NPI | - | NPPES |
| 571134452 | Other | FEDERAL IN | |
| JB021564 | Other | SC | JUA |
| 562413454 | Other | SC | SECONDARY TAX ID |
| 20234 | Other | SC | MEDICAL LICENSE |
| JB021584 | Other | JUA | |
| 562413454 | Other | FEDERAL IN | |
| 9800859 | Other | NC | MEDICAL LICENSE |
| 20 20234 | Other | SC | STATE REGISTRATION |
| GP3438 | Medicaid | SC | |
| 202346 | Medicaid | SC | |
| 75767 | Other | SC | SC PCF |
| GP3914 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 20234 (South Carolina) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Trident Medical Center | Charleston, SC | Hospital |
| Colleton Medical Center | Walterboro, SC | Hospital |
| Unc Health Nash | Rocky mount, NC | Hospital |
| Roper Hospital | Charleston, SC | Hospital |
| Roper St Francis Hospital-berkely Inc | Summerville, SC | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Cogent Healthcare Of North Carolina Pc | 7911954714 | 66 |
| Cogent Healthcare Of Georgia Pc | 2961483607 | 252 |
| Liberty Doctors Llc | 0840466017 | 44 |
| Southeastern Hospitalist Services Pc | 3476855420 | 301 |
| Entity Name | Cogent Healthcare of North Carolina PC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1548207483 PECOS PAC ID: 7911954714 Enrollment ID: O20050404001057 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Temisan L Etikerentse, MD 783 Navigators Run, Mt. Pleasant, SC 29464-2829 Ph: (843) 886-6729 | Dr Temisan L Etikerentse, MD 110 Executive Pkwy, Moncks Corner, SC 29461-3930 Ph: (843) 899-9099 |
Dr. Omolola Ajoke Omotoso, MD Internal Medicine Medicare: May Accept Medicare Assignments Practice Location: 110 Executive Parkway, Moncks Corner, SC 29461 Phone: 843-899-9099 Fax: 843-899-9091 |
Rose Delores Gibbs, MD Internal Medicine Medicare: Medicare Enrolled Practice Location: 106 W Main St, Moncks Corner, SC 29461 Phone: 843-761-1995 Fax: 843-761-3257 |
Edward Johnson Jones Iii, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 115 Executive Parkway, Moncks Corner, SC 29461 Phone: 843-761-2815 Fax: 843-869-8034 |