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121 S Evander Dr Florence SC 29506-4212 | |
(843) 432-2935 | |
(843) 799-4297 |
Full Name | |
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Speciality | Clinic/Center |
Location | 121 S Evander Dr, Florence, South Carolina |
Authorized Official Name and Position | Mark Vinson (CFO) |
Authorized Official Contact | 8436560353 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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360 N Irby St Florence SC 29501-2808 Ph: (843) 667-9414 | 121 S Evander Dr Florence SC 29506-4212 Ph: (843) 432-2935 |
NPI Number | 1841580412 |
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Provider Enumeration Date | 04/15/2011 |
Last Update Date | 09/30/2020 |
Medicare PECOS PAC ID | 4082510623 |
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Medicare Enrollment ID | O20110721000375 |
Identifier | Type | State | Issuer |
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1841580412 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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