| Rearden Internal Medicine & Geriatrics Llc | |
|
1205 Wisteria Rd Charleston SC 29407-5226 | |
| (843) 277-2771 | |
| (843) 277-2778 |
| Full Name | Rearden Internal Medicine & Geriatrics Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1205 Wisteria Rd, Charleston, South Carolina |
| Authorized Official Name and Position | Gail Lashun Rearden (OWNER) |
| Authorized Official Contact | 8432772771 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rearden Internal Medicine & Geriatrics Llc P O Box 2191 Walterboro SC 29488-3933 Ph: (843) 277-2771 | Rearden Internal Medicine & Geriatrics Llc 1205 Wisteria Rd Charleston SC 29407-5226 Ph: (843) 277-2771 |
| NPI Number | 1245552843 |
|---|---|
| Provider Enumeration Date | 02/23/2010 |
| Last Update Date | 05/24/2015 |
| Medicare PECOS PAC ID | 8123155199 |
|---|---|
| Medicare Enrollment ID | O20100422000801 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245552843 | NPI | - | NPPES |
| 42D2093779 | Other | SC | CLIA WAIVER |
| 302586 | Medicaid | SC | |
| 42D2052192 | Other | SC | CLAI WAIVER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Gail L Rearden |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568582906 PECOS PAC ID: 7618060005 Enrollment ID: I20070830000201 |
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