Healthcare Provider Details

I. General information

NPI: 1699839233
Provider Name (Legal Business Name): TRAVELERS REST INTERNAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 S POINSETT HWY
TRAVELERS REST SC
29690-1822
US

IV. Provider business mailing address

6 S POINSETT HWY
TRAVELERS REST SC
29690-1822
US

V. Phone/Fax

Practice location:
  • Phone: 864-834-7834
  • Fax: 864-834-7477
Mailing address:
  • Phone: 864-834-7834
  • Fax: 864-834-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0722
License Number StateSC

VIII. Authorized Official

Name: DR. SCOTT C. WEIKLE
Title or Position: OWNER
Credential: D.O.
Phone: 864-834-7834