| Gomed Charleston | |
|
1671 Belle Isle Ave Ste 110j Mount Pleasant SC 29464-8336 | |
| (844) 994-6633 | |
| (470) 235-1861 |
| Full Name | Gomed Charleston |
|---|---|
| Speciality | General Practice |
| 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 2011 Commerce Dr N Peachtree City GA 30269-3538 Ph: (844) 994-6633 | Gomed Charleston 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 | 02/23/2023 |
| 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 |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
| 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 | Donna Sanderson Davidson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194488403 PECOS PAC ID: 5193181451 Enrollment ID: I20230512000185 |
| Provider Name | Cori Elizabeth Sondervan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710433792 PECOS PAC ID: 0446529374 Enrollment ID: I20240201000926 |
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