MEDICARE: JAMES-WILLMOT CLINIC

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	208D00000X	General Practice Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CM2784	OTHER	SC	MEDICARE ID TYPE UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730144262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES-WILLMOT CLINIC

Provider Business Mailing Address
First Line	:	100 MEDICAL CENTER DR
Second Line	:
City	:	WOODRUFF
State	:	SC
Zip	:	29388-8704
Country	:	US
Telephone Number	:	864-476-8191
Fax Number	:	864-476-8193

Provider Business Practice Location Address
First Line	:	100 MEDICAL CENTER DR
Second Line	:
City	:	WOODRUFF
State	:	SC
Zip	:	29388-8704
Country	:	US
Telephone Number	:	864-476-8191
Fax Number	:	864-476-8193

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	C JANICE CAMPBELL
Credential	:
Telephone Number	:	864-476-8191

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	05/02/2013

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Directions to “JAMES-WILLMOT CLINIC ” Practice Location

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