| Coulter Clinic | |
|
941 Summers Ave Orangeburg SC 29115-4931 | |
| (803) 534-0437 | |
| (803) 531-1464 |
| Full Name | Coulter Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 941 Summers Ave, Orangeburg, South Carolina |
| Authorized Official Name and Position | Franklin Coulter (OWNER) |
| Authorized Official Contact | 8035340437 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coulter Clinic 941 Summers Ave Orangeburg SC 29115-4931 Ph: (803) 534-0437 | Coulter Clinic 941 Summers Ave Orangeburg SC 29115-4931 Ph: (803) 534-0437 |
| NPI Number | 1700179504 |
|---|---|
| Provider Enumeration Date | 05/26/2011 |
| Last Update Date | 05/26/2011 |
| Medicare PECOS PAC ID | 7113103995 |
|---|---|
| Medicare Enrollment ID | O20110511000649 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700179504 | NPI | - | NPPES |
| 105825 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 10582 (South Carolina) | Primary |
| Provider Name | Franklin Coulter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730103144 PECOS PAC ID: 3678750726 Enrollment ID: I20110527000141 |
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