Healthcare Provider Details

I. General information

NPI: 1902879497
Provider Name (Legal Business Name): MCLEOD PHYSICIAN ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N 8TH AVE STE 3A
DILLON SC
29536-2549
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-774-6091
  • Fax: 843-841-3814
Mailing address:
  • Phone: 843-777-7000
  • Fax: 843-777-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEANNE L MOREHOUSE
Title or Position: DIR OF OPERATIONS
Credential:
Phone: 843-777-7030