| Newton Family Medicine, Llc | |
|
1477 Tobias Gadson Blvd Charleston SC 29407-4794 | |
| (843) 766-7696 | |
| Not Available |
| Full Name | Newton Family Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1477 Tobias Gadson Blvd, Charleston, South Carolina |
| Authorized Official Name and Position | Eric Radabaugh (CFO) |
| Authorized Official Contact | 8433646695 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Newton Family Medicine, Llc 1477 Tobias Gadson Blvd Charleston SC 29407-4794 Ph: (843) 766-7696 | Newton Family Medicine, Llc 1477 Tobias Gadson Blvd Charleston SC 29407-4794 Ph: (843) 766-7696 |
| NPI Number | 1497206726 |
|---|---|
| Provider Enumeration Date | 10/21/2016 |
| Last Update Date | 10/21/2016 |
| Medicare PECOS PAC ID | 4789949223 |
|---|---|
| Medicare Enrollment ID | O20180604000737 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497206726 | NPI | - | NPPES |
| 19206 | Other | SC | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 19206 (South Carolina) | Primary |
| Provider Name | Edward M Newton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891739785 PECOS PAC ID: 4082655998 Enrollment ID: I20090604000069 |
| Provider Name | Lindsey Diane Kettinger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770836363 PECOS PAC ID: 7911150354 Enrollment ID: I20130114000454 |
| Provider Name | Ryan Wolbach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881384485 PECOS PAC ID: 0143686634 Enrollment ID: I20230525003425 |
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