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General NPI Number Information
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NPI Number | 1588592307
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Entity Type | Organization
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Legal Business Name | ROSA CLARK MEDICAL CLINIC ASSOCIATION, INC.
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Dates
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Enumeration Date | 05/12/2026
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 130 DEVELOPMENT DR
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City | WEST UNION
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State | SC
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Zip | 29696-2651
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Country | US
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Telephone | 864-882-4664
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Fax |
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Provider Business Mailing Address
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Address Line | 301 MEMORIAL DR
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City | SENECA
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State | SC
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Zip | 29672-9491
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Country | US
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Telephone | 864-614-5617
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Fax | 864-614-5617
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MISS JAMIE SHANNON LEE
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Credential |
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Telephone | 864-614-5617
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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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