| Charleston Geriatrics And Post - Acute Care Llc | |
|
930 Tall Pine Rd Mount Pleasant SC 29464-2910 | |
| (843) 209-1454 | |
| Not Available |
| Full Name | Charleston Geriatrics And Post - Acute Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 930 Tall Pine Rd, Mount Pleasant, South Carolina |
| Authorized Official Name and Position | John E Kleckley (OWNER) |
| Authorized Official Contact | 8432091454 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charleston Geriatrics And Post - Acute Care Llc 930 Tall Pine Rd Mount Pleasant SC 29464-2910 Ph: () - | Charleston Geriatrics And Post - Acute Care Llc 930 Tall Pine Rd Mount Pleasant SC 29464-2910 Ph: (843) 209-1454 |
| NPI Number | 1487031001 |
|---|---|
| Provider Enumeration Date | 05/04/2015 |
| Last Update Date | 05/04/2015 |
| Medicare PECOS PAC ID | 0244551976 |
|---|---|
| Medicare Enrollment ID | O20150608000350 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487031001 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | 29749 (South Carolina) | Primary |
| Provider Name | John Edgar Kleckley |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1356544100 PECOS PAC ID: 0840385290 Enrollment ID: I20071001000637 |
| Provider Name | Jody K Eblen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578876553 PECOS PAC ID: 7911196019 Enrollment ID: I20110105000303 |
| Provider Name | Elizabeth A Connor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639508997 PECOS PAC ID: 5698902583 Enrollment ID: I20131223000264 |
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