| Gomed Charleston LLC | |
|
1671 Belle Isle Ave Ste 110j Mount Pleasant SC 29464-8336 | |
| (844) 994-6633 | |
| (470) 235-1861 |
| Full Name | Gomed Charleston LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 1671 Belle Isle Ave Ste 110j, Mount Pleasant, South Carolina |
| Authorized Official Name and Position | Robert Allan Mester (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8133603957 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gomed Charleston LLC 2011 Commerce Dr N Peachtree City GA 30269-3538 Ph: (844) 994-6633 | Gomed Charleston LLC 1671 Belle Isle Ave Ste 110j Mount Pleasant SC 29464-8336 Ph: (844) 994-6633 |
| NPI Number | 1790254365 |
|---|---|
| Provider Enumeration Date | 11/13/2018 |
| Last Update Date | 01/06/2025 |
| Certification Date | 01/06/2025 |
| Medicare PECOS PAC ID | 6608114251 |
|---|---|
| Medicare Enrollment ID | O20190206003330 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790254365 | NPI | - | NPPES |
| 42D2160532 | Other | SC | CLIA WAIVER CERTIFICATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| Provider Name | Daniel William Fisher |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457670358 PECOS PAC ID: 8820252851 Enrollment ID: I20141010002426 |
| Provider Name | Robert Mester |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1366604415 PECOS PAC ID: 3274794227 Enrollment ID: I20161215001413 |
| Provider Name | Brittney Jeanetta Cook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053832154 PECOS PAC ID: 6204102700 Enrollment ID: I20171030000000 |
| Provider Name | Christopher Allen Pitts |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1568499754 PECOS PAC ID: 6608850912 Enrollment ID: I20190311001716 |
| Provider Name | Amber Bullard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023694163 PECOS PAC ID: 2264839869 Enrollment ID: I20210924000429 |
| Provider Name | Austin Darbyshire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689285538 PECOS PAC ID: 9335554153 Enrollment ID: I20211130003154 |
| Provider Name | Bret T Loefstedt |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1770210106 PECOS PAC ID: 5597132316 Enrollment ID: I20221108003134 |
| Provider Name | Paul Alan Rhodes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558887463 PECOS PAC ID: 4183979560 Enrollment ID: I20240429001315 |
| Provider Name | Emily Kolodziej |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013725100 PECOS PAC ID: 4486153327 Enrollment ID: I20250818001802 |
| Provider Name | Robyn Michele Kitchell |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1295247336 PECOS PAC ID: 3577828110 Enrollment ID: I20260401000521 |
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