| Magnolia Family Practice LLC | |
|
1229 Alice Dr Sumter SC 29150-1970 | |
| (803) 905-2273 | |
| Not Available |
| Full Name | Magnolia Family Practice LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 1229 Alice Dr, Sumter, South Carolina |
| Authorized Official Name and Position | John Russell Fleming (OWNER) |
| Authorized Official Contact | 8039052273 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Family Practice LLC 1229 Alice Dr Sumter SC 29150-1970 Ph: (803) 905-2273 | Magnolia Family Practice LLC 1229 Alice Dr Sumter SC 29150-1970 Ph: (803) 905-2273 |
| NPI Number | 1386282838 |
|---|---|
| Provider Enumeration Date | 12/16/2019 |
| Last Update Date | 12/16/2019 |
| Certification Date | 12/16/2019 |
| Medicare PECOS PAC ID | 8022443597 |
|---|---|
| Medicare Enrollment ID | O20200113000080 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386282838 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 207QH0002X | Family Medicine - Hospice And Palliative Medicine | () | Secondary |
| Provider Name | John R Fleming |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366448771 PECOS PAC ID: 6709799976 Enrollment ID: I20031112000637 |
| Provider Name | Leslie Andrew Beben |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1417941501 PECOS PAC ID: 2961444781 Enrollment ID: I20050523000695 |
| Provider Name | Jennifer Weich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053843623 PECOS PAC ID: 1355619818 Enrollment ID: I20170626000817 |
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