Healthcare Provider Details

I. General information

NPI: 1215991757
Provider Name (Legal Business Name): ELLEN PATRICE T TURBEVILLE MINTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICE T. MINTER MD

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E CHEVES ST
FLORENCE SC
29506-2604
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-5065
  • Fax: 843-662-2474
Mailing address:
  • Phone: 843-777-5065
  • Fax: 843-662-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20790
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: