Organization Name: | MCLEOD PHYSICIAN ASSOCIATES II |
NPI Number: | 1528162112 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAUL PROVENZANO (REGIONAL PRACTICE MANAGER/AVP) |
Mailing Address: | 755 E Smith St Timmonsville |
State: | SC US |
Postal Code: | 291619430 |
Phone Number: | 8433463900 |
Fax Number: | 8433467839 |
NPI Enumeration Date: | 09/12/2006 |
NPI Last Update Date: | 03/27/2009 |
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: |