| Woodlandway Family Practice | |
|
111 West Pine Grove Rd Fairplay SC 29643 | |
| (864) 972-5720 | |
| (864) 972-5724 |
| Full Name | Woodlandway Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 111 West Pine Grove Rd, Fairplay, South Carolina |
| Authorized Official Name and Position | Kenneth H. Becker (PRESIDENT) |
| Authorized Official Contact | 8649725720 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Woodlandway Family Practice Po Box 98 Fair Play SC 29643-0098 Ph: (864) 972-5720 | Woodlandway Family Practice 111 West Pine Grove Rd Fairplay SC 29643 Ph: (864) 972-5720 |
| NPI Number | 1891985982 |
|---|---|
| Provider Enumeration Date | 07/26/2007 |
| Last Update Date | 07/26/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891985982 | NPI | - | NPPES |
| 235720 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 23572 (South Carolina) | Primary |