MEDICARE: MRS. KELSEY RIGGS SEPTIMIO PA

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	207Q00000X	Family Medicine Physician	305193	NC
2	207QA0505X	Adult Medicine Physician	4122	SC

General Provider Information

NPI Number	:	1518557099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELSEY RIGGS SEPTIMIO PA

Provider Business Mailing Address
First Line	:	1365 BROADCLOTH ST STE 203
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-4507
Country	:	US
Telephone Number	:	919-649-8699
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 BROADCLOTH ST STE 203
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-4507
Country	:	US
Telephone Number	:	803-402-4410
Fax Number	:	803-526-7662

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

Provider Enumeration Date	:	01/19/2021
Last Update Date	:	09/22/2022

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