Organization Name: | MARLBORO CLINIC CORP |
NPI Number: | 1225258635 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEBBIE T BREWER (PROVIDER ENROLLMENT) |
Mailing Address: | 1076 Marlboro Way Suite 1 Bennettsville |
State: | SC US |
Postal Code: | 295122495 |
Phone Number: | 8434542294 |
Fax Number: | 8434542342 |
NPI Enumeration Date: | 04/26/2007 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207VX0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | Obstetrics |
Taxonomy Definition: |