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General NPI Number Information
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NPI Number | 1609270743
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Entity Type | Organization
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Legal Business Name | REAL HEALTH CLINIC
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 101 SPRINGHALL DR
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City | GOOSE CREEK
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State | SC
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Zip | 29445-5336
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Country | US
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Telephone | 843-302-0920
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Fax |
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Provider Business Mailing Address
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Address Line | 101 SPRINGHALL DRIVE
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City | GOOSE CREEK
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State | SC
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Zip | 29445
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Country | US
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Telephone | 843-302-0920
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Fax |
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Authorized Official
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Title or Position | M.D.
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Name | TONI MANOS
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Credential | M.D.
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Telephone | 843-302-0920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 1801218196
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License Number State | SC
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