| Ancillary Services-radiology | |
|
180 Wingo Way Suite 105 Mt Pleasant SC 29464 | |
| (843) 266-3540 | |
| Not Available |
| Full Name | Ancillary Services-radiology |
|---|---|
| Speciality | Family Medicine |
| Location | 180 Wingo Way, Mt Pleasant, South Carolina |
| Authorized Official Name and Position | Linda C Shoemaker (COO) |
| Authorized Official Contact | 8439378101 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ancillary Services-radiology 180 Wingo Way Suite 105 Mt Pleasant SC 29464 | Ancillary Services-radiology 180 Wingo Way Suite 105 Mt Pleasant SC 29464 Ph: (843) 266-3540 |
| NPI Number | 1497874424 |
|---|---|
| Provider Enumeration Date | 03/29/2007 |
| Last Update Date | 09/15/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497874424 | NPI | - | NPPES |
| GP2939 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (South Carolina) | Primary |
| 207R00000X | Internal Medicine | (South Carolina) | Secondary |
| 208000000X | Pediatrics | (South Carolina) | Secondary |
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