| Organization Name: | POWDERSVILLE HEALTH INTERNAL MEDICINE |
| NPI Number: | 1184083982 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NANCY MCNEELY LOLLIS (OFFICE MANAGER) |
| Mailing Address: | 3150 Highway 153 Piedmont |
| State: | SC US |
| Postal Code: | 296739498 |
| Phone Number: | 8645685018 |
| Fax Number: | 8642950095 |
| NPI Enumeration Date: | 02/22/2016 |
| NPI Last Update Date: | 02/22/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | MD38594 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |