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General NPI Number Information
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NPI Number | 1306099312
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Entity Type | Organization
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Legal Business Name | PMC PHYSICIAN NETWORK, L.L.C.
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 1795 DEVINNEY RD
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City | YORK
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State | SC
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Zip | 29745
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Country | US
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Telephone | 803-818-5995
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Fax | 803-818-5985
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Provider Business Mailing Address
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Address Line | PO BOX 742869
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City | ATLANTA
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State | GA
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Zip | 30374-2869
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Country | US
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Telephone | 803-818-5995
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Fax | 803-818-5985
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Authorized Official
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Title or Position | REGIONAL CFO, TENET
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Name | MR. WESLEY O. JAMES
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Credential |
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Telephone | 404-265-5009
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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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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