| Blue Ridge Pediatrics LLC | |
|
457b Highway 123 Seneca SC 29678-0842 | |
| (864) 888-4464 | |
| Not Available |
| Full Name | Blue Ridge Pediatrics LLC |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 457b Highway 123, Seneca, South Carolina |
| Authorized Official Name and Position | Carey Molin Gully (OWNER) |
| Authorized Official Contact | 8648884464 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Ridge Pediatrics LLC 457b Highway 123 Seneca SC 29678-0842 Ph: (864) 888-4464 | Blue Ridge Pediatrics LLC 457b Highway 123 Seneca SC 29678-0842 Ph: (864) 888-4464 |
| NPI Number | 1104130376 |
|---|---|
| Provider Enumeration Date | 07/30/2010 |
| Last Update Date | 07/30/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104130376 | NPI | - | NPPES |
| RHC195 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 261QR1300X (South Carolina) | Primary |
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