| Olga Victa, MD | |
|
164 Waccamaw Medical Park Dr, Conway, SC 29526-8903 | |
| (843) 347-5060 | |
| Not Available |
| Full Name | Olga Victa |
|---|---|
| Gender | Female |
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 164 Waccamaw Medical Park Dr, Conway, South Carolina |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205090933 | NPI | - | NPPES |
| 327877 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 4301092578 (Michigan) | Primary |
| Entity Name | Permanente Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710 |
| Mailing Address | Practice Location Address |
|---|---|
| Olga Victa, MD 7436 Catena Ln, Myrtle Beach, SC 29572-8031 Ph: () - | Olga Victa, MD 164 Waccamaw Medical Park Dr, Conway, SC 29526-8903 Ph: (843) 347-5060 |
Emmett Michael Lampkin, MD Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 164 Waccamaw Medical Park Dr, Conway, SC 29526 Phone: 843-347-5060 | |
George M. Sandoz, MD Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 8024 Myrtle Trace Dr, Conway, SC 29526 Phone: 843-234-8950 Fax: 843-234-8951 | |
Agnes Devenyi, MD Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 164 Waccamaw Medical Park Dr, Conway, SC 29526 Phone: 843-347-5060 | |
Dr. Mario S Bangco, MD Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 8024 Myrtle Trace Dr, Conway, SC 29526 Phone: 843-234-8950 Fax: 843-234-8951 | |
Dr. William A. Vanhorn, MD Psychiatry & Neurology Medicare: Medicare Enrolled Practice Location: 164 Waccamaw Medical Park Dr, Conway, SC 29526 Phone: 843-347-5060 Fax: 843-347-3959 | |
Dr. Kurt Klauburg, DO Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 164 Waccamaw Medical Park Dr, Conway, SC 29526 Phone: 843-347-5060 Fax: 843-347-3959 |