| One Source Integrative Medicine | |
|
1601a W Lucas St Florence SC 29501-1225 | |
| (843) 992-7604 | |
| Not Available |
| Full Name | One Source Integrative Medicine |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 02/10/2022 |
| Last Update Date | 02/10/2022 |
| Certification Date | 02/10/2022 |
| Medicare PECOS PAC ID | 1052791472 |
|---|---|
| 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 | (NU) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (NU) | Primary |
| Provider Name | Jennifer Marlena Evans |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1578993820 PECOS PAC ID: 8921238643 Enrollment ID: I20140225001571 |
| Provider Name | Tasha M Broach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528446994 PECOS PAC ID: 1850777533 Enrollment ID: I20221004000930 |
| Provider Name | Jessica Sanders |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134841372 PECOS PAC ID: 8022487370 Enrollment ID: I20221208003184 |
| Provider Name | Shalanda E Pollins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093418683 PECOS PAC ID: 0941668776 Enrollment ID: I20230626003061 |
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