| Fetter Health Care Network, Inc | |
|
110 Executive Pkwy Moncks Corner SC 29461-3930 | |
| (843) 761-7744 | |
| Not Available |
| Full Name | Fetter Health Care Network, Inc |
|---|---|
| Speciality | Pediatrics |
| Location | 110 Executive Pkwy, Moncks Corner, South Carolina |
| Authorized Official Name and Position | Reuben J Pettiford (CEO) |
| Authorized Official Contact | 8437224112 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fetter Health Care Network, Inc 51 Nassau Street Charleston SC 29403-5513 Ph: (843) 722-4112 | Fetter Health Care Network, Inc 110 Executive Pkwy Moncks Corner SC 29461-3930 Ph: (843) 761-7744 |
| NPI Number | 1932213378 |
|---|---|
| Provider Enumeration Date | 08/19/2006 |
| Last Update Date | 04/15/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932213378 | NPI | - | NPPES |
| FQC049 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
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