MEDICARE: GREENWOOD COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1063612984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWOOD COUNTY

Provider Business Mailing Address
First Line	:	PO BOX 3312
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29648-3312
Country	:	US
Telephone Number	:	864-942-8766
Fax Number	:

Provider Business Practice Location Address
First Line	:	528 MONUMENT ST STE 105
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29646-2634
Country	:	US
Telephone Number	:	864-942-8766
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MISS TETEASA MICHELLE SHAW
Credential	:
Telephone Number	:	864-942-8766

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	07/19/2007

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Directions to “GREENWOOD COUNTY ” Practice Location

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