| Anderson Family Care, Pa | |
|
3424 Clemson Blvd Anderson SC 29621-1357 | |
| (864) 261-4350 | |
| (864) 261-4097 |
| Full Name | Anderson Family Care, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 3424 Clemson Blvd, Anderson, South Carolina |
| Authorized Official Name and Position | Wajdi Ali Dbouk (OWNER) |
| Authorized Official Contact | 8642614350 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Anderson Family Care, Pa 3424 Clemson Blvd Anderson SC 29621-1357 Ph: (864) 261-4350 | Anderson Family Care, Pa 3424 Clemson Blvd Anderson SC 29621-1357 Ph: (864) 261-4350 |
| NPI Number | 1942261185 |
|---|---|
| Provider Enumeration Date | 03/29/2006 |
| Last Update Date | 03/08/2022 |
| Medicare PECOS PAC ID | 6103871173 |
|---|---|
| Medicare Enrollment ID | O20050314000436 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942261185 | NPI | - | NPPES |
| GP2619 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Wajdi A Dbouk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023073764 PECOS PAC ID: 4284689258 Enrollment ID: I20120210000316 |
| Provider Name | Ashlea B Bates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326517194 PECOS PAC ID: 5496097636 Enrollment ID: I20190508002132 |
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