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General NPI Number Information
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NPI Number | 1093883001
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Entity Type | Organization
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Legal Business Name | CHESTERFIELD CLINIC CORP
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 715 S DOCTORS DR SUITE F
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City | CHERAW
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State | SC
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Zip | 29520-7113
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Country | US
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Telephone | 843-537-1111
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Fax | 843-537-9393
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Provider Business Mailing Address
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Address Line | 715 S DOCTORS DR SUITE F
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City | CHERAW
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State | SC
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Zip | 29520-7113
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Country | US
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Telephone | 843-537-1111
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Fax | 843-537-9393
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Authorized Official
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Title or Position | DIRECTOR OF PROVIDER ENROLLMENT
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Name | DEBBIE BREWER
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Credential |
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Telephone | 615-465-7626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | SC
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