MEDICARE: PROACTIVE MD SC,P.A.

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1811640667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROACTIVE MD SC,P.A.

Provider Business Mailing Address
First Line	:	124 ALLAWOOD CT.
Second Line	:	ALLAWOOD CT
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681
Country	:	US
Telephone Number	:	864-501-0751
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 W MONTAGUE AVE
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29418-6099
Country	:	US
Telephone Number	:	843-885-4900
Fax Number	:

Authorized Official
Title or Position	:	CMO
Name	:	MARK ALLEN KEMBLE
Credential	:	MD
Telephone Number	:	864-501-0751

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	04/08/2025

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