| Longevity Clinical Ltc Associates Of South Carolina, Pc | |
|
611 E Hampton St Anderson SC 29624-2814 | |
| (864) 226-5054 | |
| Not Available |
| Full Name | Longevity Clinical Ltc Associates Of South Carolina, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 611 E Hampton St, Anderson, South Carolina |
| Authorized Official Name and Position | Diane L Vincur (LWC PRACTICE MANAGER) |
| Authorized Official Contact | 5618152427 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longevity Clinical Ltc Associates Of South Carolina, Pc 11780 Us Highway 1 Ste N107 North Palm Beach FL 33408-3007 Ph: (561) 815-2427 | Longevity Clinical Ltc Associates Of South Carolina, Pc 611 E Hampton St Anderson SC 29624-2814 Ph: (864) 226-5054 |
| NPI Number | 1184317984 |
|---|---|
| Provider Enumeration Date | 05/30/2023 |
| Last Update Date | 05/30/2023 |
| Medicare PECOS PAC ID | 6800241001 |
|---|---|
| Medicare Enrollment ID | O20231009000147 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184317984 | NPI | - | NPPES |
| Provider Name | Waseem Ghannam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306080510 PECOS PAC ID: 5092971085 Enrollment ID: I20230118002822 |
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