| Organization Name: | MICHAEL WATSON RURAL HEALTH CLINIC |
| NPI Number: | 1669409009 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM D GLENN (OWNER) |
| Mailing Address: | 498 North St Bamberg |
| State: | SC US |
| Postal Code: | 290031377 |
| Phone Number: | 8032455144 |
| Fax Number: | 8032456277 |
| NPI Enumeration Date: | 06/28/2006 |
| NPI Last Update Date: | 04/28/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 261QR1300X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |