| Magnolia Endocrinology, Llc | |
|
204 Parsons Rd Summerville SC 29483-3348 | |
| (854) 201-3636 | |
| Not Available |
| Full Name | Magnolia Endocrinology, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 204 Parsons Rd, Summerville, South Carolina |
| Authorized Official Name and Position | Temple Mewshaw (OWNER) |
| Authorized Official Contact | 8542013636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Endocrinology, Llc 204 Parsons Rd Summerville SC 29483-3348 Ph: (854) 201-3636 | Magnolia Endocrinology, Llc 204 Parsons Rd Summerville SC 29483-3348 Ph: (854) 201-3636 |
| NPI Number | 1922639897 |
|---|---|
| Provider Enumeration Date | 01/30/2020 |
| Last Update Date | 01/21/2022 |
| Medicare PECOS PAC ID | 3779913934 |
|---|---|
| Medicare Enrollment ID | O20200430002763 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922639897 | NPI | - | NPPES |
| K109 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Kimberly Boggs Pugh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912965831 PECOS PAC ID: 5799752085 Enrollment ID: I20040915000951 |
| Provider Name | Sarah I Dolven |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1164430682 PECOS PAC ID: 0840259719 Enrollment ID: I20041006000914 |
| Provider Name | John B Schenck |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1942362793 PECOS PAC ID: 7810930922 Enrollment ID: I20070618000481 |
| Provider Name | Amelia Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205316858 PECOS PAC ID: 8325383623 Enrollment ID: I20181214000097 |
| Provider Name | Katalina R Funke |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1386024099 PECOS PAC ID: 8325348865 Enrollment ID: I20220325001902 |
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