| Private Physician Group LLC | |
|
1698 Highway 160 W Ste 200 Fort Mill SC 29708-8034 | |
| (516) 590-4475 | |
| (803) 267-8229 |
| Full Name | Private Physician Group LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 1698 Highway 160 W Ste 200, Fort Mill, South Carolina |
| Authorized Official Name and Position | Catherine L. Ferrara (OWNER) |
| Authorized Official Contact | 5165904475 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Private Physician Group LLC 22076 Preswick Dr Fort Mill SC 29707-6202 Ph: (516) 590-4475 | Private Physician Group LLC 1698 Highway 160 W Ste 200 Fort Mill SC 29708-8034 Ph: (516) 590-4475 |
| NPI Number | 1639841323 |
|---|---|
| Provider Enumeration Date | 09/30/2021 |
| Last Update Date | 09/30/2021 |
| Certification Date | 09/30/2021 |
| Medicare PECOS PAC ID | 9335530948 |
|---|---|
| Medicare Enrollment ID | O20211215000943 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639841323 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Catherine L Ferrara |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386750206 PECOS PAC ID: 7315957339 Enrollment ID: I20180717004157 |
| Provider Name | Anthony a Foto |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396851218 PECOS PAC ID: 4688684368 Enrollment ID: I20190515002924 |
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