| St Paul's Medical Group, Inc | |
|
7610 Highway 164 Hollywood SC 29449 | |
| (843) 889-8018 | |
| (843) 889-9133 |
| Full Name | St Paul's Medical Group, Inc |
|---|---|
| Speciality | Clinic/center |
| Location | 7610 Highway 164, Hollywood, South Carolina |
| Authorized Official Name and Position | Marsha Gay Delavan (PRESIDENT) |
| Authorized Official Contact | 8438898018 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St Paul's Medical Group, Inc Po Box 1355 Hollywood SC 29449-1355 Ph: (843) 889-8018 | St Paul's Medical Group, Inc 7610 Highway 164 Hollywood SC 29449 Ph: (843) 889-8018 |
| NPI Number | 1740402130 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 12/28/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740402130 | NPI | - | NPPES |
| 42D0968299 | Other | SC | CLIA NUMBER |
| GP2603 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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