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General NPI Number Information
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NPI Number | 1386073302
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Entity Type | Organization
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Legal Business Name | IMC OF SOUTH CAROLINA
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 2420 TWO NOTCH RD
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City | LEXINGTON
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State | SC
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Zip | 29072-7963
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Country | US
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Telephone | 850-656-1837
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Fax |
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Provider Business Mailing Address
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Address Line | 2615 CENTENNIAL BLVD SUITE 101
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City | TALLAHASSEE
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State | FL
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Zip | 32308-0586
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Country | US
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Telephone | 850-656-1837
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Fax | 850-877-2917
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Authorized Official
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Title or Position | INSURANCE & BILLING COORDINATOR
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Name | MRS. TARA N. ATKINSON
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Credential |
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Telephone | 850-656-1837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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