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General NPI Number Information
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NPI Number | 1629189766
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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 | 08/31/2006
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 701 CASHUA FERRY RD
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City | DARLINGTON
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State | SC
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Zip | 29532-8488
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Country | US
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Telephone | 843-777-4217
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Fax | 843-777-4296
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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 | 843-777-4217
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Fax | 843-777-4296
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MR. 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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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