Healthcare Provider Details

I. General information

NPI: 1780658195
Provider Name (Legal Business Name): MCLEOD PHYSICIAN ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BOZARD ST
MANNING SC
29102-2935
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 803-435-8828
  • Fax: 803-435-2239
Mailing address:
  • Phone: 843-777-7030
  • Fax: 843-777-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEANNE MOREHOUSE
Title or Position: DIR OF OPERATIONS
Credential:
Phone: 843-777-7030