| Life In A Blender Family Medicine, Llc | |
|
132 Professional Park Dr Unit A Conway SC 29526-9268 | |
| (843) 347-4900 | |
| (843) 347-4901 |
| Full Name | Life In A Blender Family Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 132 Professional Park Dr Unit A, Conway, South Carolina |
| Authorized Official Name and Position | Joseph Papotto (OWNER, PHYSICIAN) |
| Authorized Official Contact | 8433474900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life In A Blender Family Medicine, Llc 132 Professional Park Dr Unit A Conway SC 29526-9268 Ph: (843) 347-4900 | Life In A Blender Family Medicine, Llc 132 Professional Park Dr Unit A Conway SC 29526-9268 Ph: (843) 347-4900 |
| NPI Number | 1235574740 |
|---|---|
| Provider Enumeration Date | 05/10/2013 |
| Last Update Date | 05/10/2013 |
| Medicare PECOS PAC ID | 3779724414 |
|---|---|
| Medicare Enrollment ID | O20130723000768 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235574740 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Joseph J Papotto |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114970431 PECOS PAC ID: 6406871623 Enrollment ID: I20070124000480 |
| Provider Name | Tara Jean Zebadua |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184011900 PECOS PAC ID: 3274846175 Enrollment ID: I20150721003106 |
| Provider Name | Vered Butbul Benezra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528611605 PECOS PAC ID: 3779915988 Enrollment ID: I20191108001671 |
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