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1124194451

NPI Code Detail

MEDICARE: DR. HEIDI ENEJOSA RODILLO MD

MEDICARE: DR. HEIDI ENEJOSA RODILLO MD

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	207R00000X	Internal Medicine Physician	11698	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	080085988	OTHER	SC	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	582366449	OTHER		TAX ID
2	11698	OTHER	SC	SC LICENSE NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124194451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEIDI ENEJOSA RODILLO MD

Provider Business Mailing Address
First Line	:	PO BOX 968
Second Line	:
City	:	ABBEVILLE
State	:	SC
Zip	:	29620-0968
Country	:	US
Telephone Number	:	864-366-9681
Fax Number	:	864-366-5600

Provider Business Practice Location Address
First Line	:	901 W GREENWOOD ST STE 1
Second Line	:
City	:	ABBEVILLE
State	:	SC
Zip	:	29620-5727
Country	:	US
Telephone Number	:	864-366-9681
Fax Number	:	864-366-5600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	01/06/2023

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Directions to “ DR. HEIDI ENEJOSA RODILLO MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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