=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356988984
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY MEDICINE AND MOHR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2019
-----------------------------------------------------
Last Update Date | 02/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2811 W PALMETTO ST STE B
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29501-5931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-407-9010
-----------------------------------------------------
Fax | 844-629-6711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2811 W PALMETTO ST STE B
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29501-5931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-407-9010
-----------------------------------------------------
Fax | 844-629-6711
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING OWNER
-----------------------------------------------------
Name | DR. RICHARD EUGENE MOHR III
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 843-407-9010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------