Healthcare Provider Details

I. General information

NPI: 1437648904
Provider Name (Legal Business Name): ONSITE HEALTHCARE AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 FRANKLIN SQUARE WAY STE A
EASLEY SC
29642-3715
US

IV. Provider business mailing address

105 FRANKLIN SQUARE WAY STE A
EASLEY SC
29642-3715
US

V. Phone/Fax

Practice location:
  • Phone: 864-442-4110
  • Fax:
Mailing address:
  • Phone: 186-444-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18996
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number18997
License Number StateSC

VIII. Authorized Official

Name: GRANT LEE CLUXTON
Title or Position: CEO
Credential: NP
Phone: 864-442-4110