MEDICARE: MCLEOD PHYSICIAN ASSOCIATES II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	=========	OTHER	SC	BLUE CROSS BLUE SHIELD
3	=========	OTHER	SC	BLUE CHOICE

General Provider Information

NPI Number	:	1043283591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCLEOD PHYSICIAN ASSOCIATES II

Provider Business Mailing Address
First Line	:	PO BOX 3239
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29502-3239
Country	:	US
Telephone Number	:	843-777-7400
Fax Number	:	843-777-7440

Provider Business Practice Location Address
First Line	:	101 WILLIAM H. JOHNSON STREET
Second Line	:	SUITE 500
City	:	FLORENCE
State	:	SC
Zip	:	29506-2772
Country	:	US
Telephone Number	:	843-777-7400
Fax Number	:	843-777-7440

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	KENNETH D. BEASLEY
Credential	:
Telephone Number	:	843-777-7010

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	06/03/2022

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Practice Location Address:

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Practice Fax: 843-777-7311

Directions to “MCLEOD PHYSICIAN ASSOCIATES II ” Practice Location

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