| Golden Corner Family Prac | |
|
1205 N Highway 11 West Union SC 29696-2715 | |
| (864) 638-5402 | |
| (864) 638-6126 |
| Full Name | Golden Corner Family Prac |
|---|---|
| Speciality | Family Medicine |
| Location | 1205 N Highway 11, West Union, South Carolina |
| Authorized Official Name and Position | Edward H. Booker (CEO) |
| Authorized Official Contact | 8646385402 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Golden Corner Family Prac Po Box 219 West Union SC 29696-0219 Ph: (864) 638-5402 | Golden Corner Family Prac 1205 N Highway 11 West Union SC 29696-2715 Ph: (864) 638-5402 |
| NPI Number | 1184771321 |
|---|---|
| Provider Enumeration Date | 01/03/2007 |
| Last Update Date | 03/17/2010 |
| Medicare PECOS PAC ID | 5799836672 |
|---|---|
| Medicare Enrollment ID | O20090707000100 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184771321 | NPI | - | NPPES |
| 094953 | Medicaid | SC | |
| L31366 | Medicaid | SC | |
| L31357 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (South Carolina) | Primary |
| Provider Name | Edward H Booker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386701563 PECOS PAC ID: 4183683444 Enrollment ID: I20041004000781 |
| Provider Name | Christina A Booker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205993466 PECOS PAC ID: 7214061795 Enrollment ID: I20100819000399 |
| Provider Name | Edward Henry Booker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669539839 PECOS PAC ID: 2961553854 Enrollment ID: I20100819000835 |
| Provider Name | Lisa A Arthur-banning |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265679526 PECOS PAC ID: 7517148877 Enrollment ID: I20110221000578 |