Healthcare Provider Details

I. General information

NPI: 1508874488
Provider Name (Legal Business Name): MCLEOD PHYSICIAN ASSOCIATES II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 E CHEVES ST
FLORENCE SC
29506-2711
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-2564
  • Fax: 843-777-5135
Mailing address:
  • Phone: 843-777-2564
  • Fax: 843-777-5135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEFF MURRELL
Title or Position: REGIONAL PRACTICE MANAGER/AVP
Credential:
Phone: 843-777-7093