| Consultorio Medico Latino | |
|
2810 Ashley Phosphate Rd Ste B4 North Charleston SC 29418-6406 | |
| (843) 553-7744 | |
| (843) 553-7734 |
| Full Name | Consultorio Medico Latino |
|---|---|
| Speciality | Family Medicine |
| Location | 2810 Ashley Phosphate Rd Ste B4, North Charleston, South Carolina |
| Authorized Official Name and Position | Stephanie Jaquez (SOLE MBR) |
| Authorized Official Contact | 8437351887 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Consultorio Medico Latino 2810 Ashley Phosphate Rd Ste B4 North Charleston SC 29418-6406 Ph: (843) 553-7744 | Consultorio Medico Latino 2810 Ashley Phosphate Rd Ste B4 North Charleston SC 29418-6406 Ph: (843) 553-7744 |
| NPI Number | 1790319408 |
|---|---|
| Provider Enumeration Date | 03/03/2020 |
| Last Update Date | 07/06/2021 |
| Medicare PECOS PAC ID | 7911338587 |
|---|---|
| Medicare Enrollment ID | O20200514001920 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790319408 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Terry Duane Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730167651 PECOS PAC ID: 2466502398 Enrollment ID: I20090616000364 |
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