Healthcare Provider Details

I. General information

NPI: 1760696173
Provider Name (Legal Business Name): COMPREHENSIVE FAMILY CARE OF BLUFFTON PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GREENWOOD DR SUITE C
HILTON HEAD ISLAND SC
29928
US

IV. Provider business mailing address

PO BOX 3406
BLUFFTON SC
29910-3406
US

V. Phone/Fax

Practice location:
  • Phone: 843-341-3232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14780
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK MICHAEL JORDAN
Title or Position: OWNER
Credential: MD
Phone: 843-341-3232