Healthcare Provider Details

I. General information

NPI: 1922630912
Provider Name (Legal Business Name): MEDASIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 JOHN ST STE 4B
GREER SC
29651-1463
US

IV. Provider business mailing address

700 PLAZA CIR STE N
CLINTON SC
29325-7556
US

V. Phone/Fax

Practice location:
  • Phone: 864-400-8293
  • Fax:
Mailing address:
  • Phone: 864-334-7727
  • Fax: 864-655-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NANCY PATEL
Title or Position: OWNER
Credential: DO
Phone: 864-400-8293