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General NPI Number Information
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NPI Number | 1346344934
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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 | 09/12/2006
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 705 N 8TH AVE STE 3A
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City | DILLON
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State | SC
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Zip | 29536-2549
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Country | US
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Telephone | 843-774-6091
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Fax | 843-841-3814
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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 | 843-774-6091
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Fax | 843-841-3814
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | KENNETH D. BEASLEY
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Credential |
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Telephone | 843-777-7010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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