| William David Isenhower Jr, MD | |
|
1015 Spring St, Greenwood, SC 29646-3831 | |
| (864) 227-6741 | |
| Not Available |
| Full Name | William David Isenhower Jr |
|---|---|
| Gender | Male |
| Speciality | Otolaryngology |
| Location | 1015 Spring St, Greenwood, 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 |
|---|---|---|---|
| 1982788725 | NPI | - | NPPES |
| 164333 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Y00000X | Otolaryngology | 16433 (South Carolina) | Primary |
| Entity Name | Self Medical Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1982836847 PECOS PAC ID: 6002953916 Enrollment ID: O20091027000071 |
| Mailing Address | Practice Location Address |
|---|---|
| William David Isenhower Jr, MD 1325 Spring St, Greenwood, SC 29646-3860 Ph: (864) 725-4111 | William David Isenhower Jr, MD 1015 Spring St, Greenwood, SC 29646-3831 Ph: (864) 227-6741 |
Gregory Tarasidis, MD Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 1015 Spring St, Greenwood, SC 29646 Phone: 864-227-6741 Fax: 864-227-2026 | |
Kyle W Scates, MD Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 1015 Spring St, Greenwood, SC 29646 Phone: 864-227-6741 Fax: 864-227-2026 | |
Kevin R Rust, MD Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 1015 Spring St, Greenwood, SC 29646 Phone: 864-227-6741 Fax: 864-227-2026 |