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General NPI Number Information
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NPI Number | 1134787641
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Entity Type | Organization
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Legal Business Name | SELECT PHYSICIANS CARE
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 05/30/2019
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Provider Practice Location Address
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Address Line | 1 STILL HOPES DR
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-7164
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Country | US
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Telephone | 803-796-6490
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2959
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City | WEST COLUMBIA
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State | SC
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Zip | 29171-2959
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Country | US
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Telephone | 803-796-6490
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Fax |
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Authorized Official
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Title or Position | CEO/EXECUTIVE DIRECTOR
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Name | MR. DANNY LYNN SANFORD
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Credential |
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Telephone | 803-739-5001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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