Healthcare Provider Details

I. General information

NPI: 1831578301
Provider Name (Legal Business Name): MCLEOD PHYSICIAN ASSOCIATES II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 CHESTERFIELD HWY
CHERAW SC
29520-7002
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-537-7881
  • Fax: 843-320-3492
Mailing address:
  • Phone: 843-777-7162
  • Fax: 843-777-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: DANE P. FICCO
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 843-777-7000