One Source Integrative Medicine | |
1601a W Lucas St Florence SC 29501-1225 | |
(843) 992-7604 | |
Not Available |
Full Name | One Source Integrative Medicine |
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Speciality | Physical Medicine & Rehabilitation |
Location | 1601a W Lucas St, Florence, South Carolina |
Authorized Official Name and Position | Jennifer M Evans (OWNER) |
Authorized Official Contact | 8439927604 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
One Source Integrative Medicine 3202 W Forest Lake Dr Florence SC 29501-8267 Ph: (843) 992-7604 | One Source Integrative Medicine 1601a W Lucas St Florence SC 29501-1225 Ph: (843) 992-7604 |
NPI Number | 1912651647 |
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Provider Enumeration Date | 02/10/2022 |
Last Update Date | 02/10/2022 |
Medicare PECOS PAC ID | 1052791472 |
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Medicare Enrollment ID | O20220701001519 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912651647 | NPI | - | NPPES |
1578993820 | Other | SC | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Primary |
Provider Name | Jennifer Marlena Evans |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1578993820 PECOS PAC ID: 8921238643 Enrollment ID: I20140225001571 |
Provider Name | Tasha M Broach |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528446994 PECOS PAC ID: 1850777533 Enrollment ID: I20221004000930 |
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