MEDICARE: GREAT FALLS CONSULTING LLC

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

General Provider Information

NPI Number	:	1811647563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT FALLS CONSULTING LLC

Provider Business Mailing Address
First Line	:	503 CHESTER AVE STE A
Second Line	:
City	:	GREAT FALLS
State	:	SC
Zip	:	29055-1207
Country	:	US
Telephone Number	:	803-482-7545
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 CHESTER AVE STE A
Second Line	:
City	:	GREAT FALLS
State	:	SC
Zip	:	29055-1207
Country	:	US
Telephone Number	:	803-482-7545
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	CHRISTOPHER KENNINGTON
Credential	:
Telephone Number	:	803-899-9561

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	11/22/2022

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Directions to “GREAT FALLS CONSULTING LLC ” Practice Location

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