| Medical Group Of The Carolinas - Family Medicine - Converse Heights | |
|
120 Heywood Ave Suite 200 Spartanburg SC 29302-1210 | |
| (864) 573-9595 | |
| (864) 585-3752 |
| Full Name | Medical Group Of The Carolinas - Family Medicine - Converse Heights |
|---|---|
| Speciality | Family Medicine |
| Location | 120 Heywood Ave, Spartanburg, South Carolina |
| Authorized Official Name and Position | Kenneth Meinke (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 8645606000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Group Of The Carolinas - Family Medicine - Converse Heights Po Box 743070 Atlanta GA 30374-3070 Ph: (864) 560-4304 | Medical Group Of The Carolinas - Family Medicine - Converse Heights 120 Heywood Ave Suite 200 Spartanburg SC 29302-1210 Ph: (864) 573-9595 |
| NPI Number | 1003900143 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 12/09/2014 |
| Medicare PECOS PAC ID | 3072425297 |
|---|---|
| Medicare Enrollment ID | O20061113000402 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003900143 | NPI | - | NPPES |
| 89014EG | Medicaid | NC | |
| GP5638 | Medicaid | SC | |
| CN1627 | Other | SC | RAILROAD MEDICARE GROUP # |
| GP1118 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| Provider Name | Philip Andrew Mahoney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194779017 PECOS PAC ID: 8224010061 Enrollment ID: I20040604000162 |
| Provider Name | Ginger Blatchford Boyle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043298011 PECOS PAC ID: 2163402413 Enrollment ID: I20040726000770 |
| Provider Name | George Liston Bass |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356393680 PECOS PAC ID: 9032212717 Enrollment ID: I20070319000144 |
| Provider Name | Scott A Coley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184694168 PECOS PAC ID: 1850436833 Enrollment ID: I20100302000320 |
| Provider Name | Manuel A Dorna-pesquera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689650376 PECOS PAC ID: 7618015603 Enrollment ID: I20110104000932 |
| Provider Name | Vincent Slater |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306000948 PECOS PAC ID: 6204004591 Enrollment ID: I20110712000163 |
| Provider Name | Jamie L Kilcoyne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316293947 PECOS PAC ID: 5294982740 Enrollment ID: I20120906000037 |
| Provider Name | Sheryl M Bankston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972859130 PECOS PAC ID: 8224278486 Enrollment ID: I20130711000303 |
| Provider Name | Natalie N Kellett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376995159 PECOS PAC ID: 1658668710 Enrollment ID: I20160919000389 |
| Provider Name | James C Thompson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881666790 PECOS PAC ID: 6204823735 Enrollment ID: I20161202001405 |
| Provider Name | Janessa Marie Perez Motlis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164865473 PECOS PAC ID: 1153690755 Enrollment ID: I20170712002754 |
| Provider Name | Cory Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083950935 PECOS PAC ID: 1557600640 Enrollment ID: I20190307001874 |
| Provider Name | Heather C Stokes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124583117 PECOS PAC ID: 4486995230 Enrollment ID: I20190404002446 |
| Provider Name | Tara Ann Wheeler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104213677 PECOS PAC ID: 7012212442 Enrollment ID: I20190907000379 |
| Provider Name | Nicole Filian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992357149 PECOS PAC ID: 2163859349 Enrollment ID: I20200227002785 |
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Proactive Md Tindall Spartanburg Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2273 Hayne St., Spartanburg, SC 29301 Phone: 864-541-0555 Fax: 864-345-7898 | |
Family Physicians Of Spartanburg Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1250 John B White Sr Blvd, Spartanburg, SC 29306 Phone: 864-576-9201 |