| Revived Medical Community Clinic | |
|
2724 W Palmetto St Ste 5 Florence SC 29501-4909 | |
| (843) 799-2649 | |
| Not Available |
| Full Name | Revived Medical Community Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2724 W Palmetto St Ste 5, Florence, South Carolina |
| Authorized Official Name and Position | Lavanda Martin (CEO,OWNER) |
| Authorized Official Contact | 8437992649 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revived Medical Community Clinic 2724 W Palmetto St Ste 5 Florence SC 29501-4909 Ph: (843) 799-2649 | Revived Medical Community Clinic 2724 W Palmetto St Ste 5 Florence SC 29501-4909 Ph: (843) 799-2649 |
| NPI Number | 1306653688 |
|---|---|
| Provider Enumeration Date | 12/11/2024 |
| Last Update Date | 01/06/2025 |
| Medicare PECOS PAC ID | 3173043387 |
|---|---|
| Medicare Enrollment ID | O20250218003226 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306653688 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Lavanda Ayana Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548936404 PECOS PAC ID: 3476951195 Enrollment ID: I20250218003343 |
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