Organization Name: | MCLEOD PHYSICIAN ASSOCIATES II |
NPI Number: | 1205113248 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANE P FICCO (SENIOR VICE PRESIDENT) |
Mailing Address: | 3109 Casey St Loris |
State: | SC US |
Postal Code: | 295692807 |
Phone Number: | 8437569292 |
Fax Number: | 8437569260 |
NPI Enumeration Date: | 11/04/2011 |
NPI Last Update Date: | 01/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |