Organization Name: | MONCKS CORNER PEDIATRICS LLC |
NPI Number: | 1245550821 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSEPH R WEST (OWNER) |
Mailing Address: | 5000 Epson Plantation Dr Ste B Moncks Corner |
State: | SC US |
Postal Code: | 294613979 |
Phone Number: | 8437612000 |
Fax Number: | 8437612267 |
NPI Enumeration Date: | 06/07/2010 |
NPI Last Update Date: | 06/07/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |