| St Pauls Medical Group | |
|
7610 Highway 164 Hollywood SC 29449 | |
| (843) 889-8018 | |
| (843) 889-9133 |
| Full Name | St Pauls Medical Group |
|---|---|
| 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 | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Pauls Medical Group Po Box 1355 Hollywood SC 29449-1355 Ph: (843) 889-8018 | St Pauls Medical Group 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 |
| Medicare PECOS PAC ID | 9436187986 |
|---|---|
| Medicare Enrollment ID | O20050727000442 |
| 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 |
| Provider Name | Anne Knight |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992816821 PECOS PAC ID: 0749294130 Enrollment ID: I20060206000885 |
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