| Caresouth Carolina, Inc | |
|
204 Perry Wiley Way Chesterfield SC 29709-5701 | |
| (843) 623-5080 | |
| Not Available |
| Full Name | Caresouth Carolina, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 204 Perry Wiley Way, Chesterfield, South Carolina |
| Authorized Official Name and Position | Ann Lewis (CEO) |
| Authorized Official Contact | 8438570111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Caresouth Carolina, Inc Po Box 1090 Hartsville SC 29551-1090 Ph: () - | Caresouth Carolina, Inc 204 Perry Wiley Way Chesterfield SC 29709-5701 Ph: (843) 623-5080 |
| NPI Number | 1629015755 |
|---|---|
| Provider Enumeration Date | 05/31/2006 |
| Last Update Date | 04/16/2021 |
| Medicare PECOS PAC ID | 1052221314 |
|---|---|
| Medicare Enrollment ID | O20041217000272 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629015755 | NPI | - | NPPES |
| FQC064 | Medicaid | SC | |
| CBP012 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Ohio Valley Physicians Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1218 East Blvd, Chesterfield, SC 29709 Phone: 843-623-7062 | |
Caresouth Carolina, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 120 Commons Drive, Chesterfield, SC 29709 Phone: 843-623-2970 Fax: 843-623-7112 |