| South Main Medical Associates, Llc | |
|
1317 S Main Rd Suite 2 C Vineland NJ 08360-6511 | |
| (856) 213-6080 | |
| (856) 213-6092 |
| Full Name | South Main Medical Associates, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1317 S Main Rd, Vineland, New Jersey |
| Authorized Official Name and Position | Olga Kaczaj (OWNER) |
| Authorized Official Contact | 8562136080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Main Medical Associates, Llc 1317 S Main Rd Suite 2 C Vineland NJ 08360-6511 Ph: (856) 213-6080 | South Main Medical Associates, Llc 1317 S Main Rd Suite 2 C Vineland NJ 08360-6511 Ph: (856) 213-6080 |
| NPI Number | 1346537917 |
|---|---|
| Provider Enumeration Date | 07/05/2011 |
| Last Update Date | 07/05/2011 |
| Medicare PECOS PAC ID | 3577735406 |
|---|---|
| Medicare Enrollment ID | O20111018000729 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346537917 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Stephanie M Shustock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891941332 PECOS PAC ID: 1850450040 Enrollment ID: I20081103000371 |
| Provider Name | Olga Kaczaj |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518055755 PECOS PAC ID: 1557419389 Enrollment ID: I20100928001203 |
| Provider Name | Natalie A Ramos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720866361 PECOS PAC ID: 6406206465 Enrollment ID: I20240103001919 |
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