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General NPI Number Information
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NPI Number | 1285890186
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Entity Type | Organization
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Legal Business Name | SANTEE FAMILY MEDICAL CTR
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 309 SANTEE RIVER PLZ
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City | SANTEE
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State | SC
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Zip | 29142
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Country | US
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Telephone | 803-854-3940
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Fax | 803-854-3945
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Provider Business Mailing Address
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Address Line | 309 SANTEE RIVER PLZ
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City | SANTEE
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State | SC
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Zip | 29142
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Country | US
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Telephone | 803-854-3940
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Fax | 803-854-3945
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Authorized Official
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Title or Position | OWNER
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Name | DR. GOSSIE C HEATH
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Credential | M.D
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Telephone | 803-854-3940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 13454
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 13454
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License Number State | SC
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