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General NPI Number Information
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NPI Number | 1336688316
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Entity Type | Organization
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Legal Business Name | MCLEOD PHYSICIAN ASSOCIATES II
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Dates
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Enumeration Date | 02/23/2017
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Last Update Date | 03/10/2017
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Provider Practice Location Address
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Address Line | 2021 N MYRTLE POINT BLVD SUITE 102
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-2224
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Country | US
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Telephone | 843-366-3030
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Fax | 843-366-3031
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Provider Business Mailing Address
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Address Line | PO BOX 3239
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City | FLORENCE
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State | SC
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Zip | 29502-3239
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Country | US
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Telephone | 843-777-7120
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Fax | 843-777-7102
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Authorized Official
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Title or Position | SENITOR VICE PRESIDENT
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Name | DANE P. FICCO
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Credential |
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Telephone | 843-777-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | SC
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