MEDICARE: ANDERSON HEALTH & WELLNESS CENTER LLC

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	261QI0500X	Infusion Therapy Clinic/Center		SC

General Provider Information

NPI Number	:	1285874925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON HEALTH & WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	1510 N FANT ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-4708
Country	:	US
Telephone Number	:	864-642-9300
Fax Number	:	864-642-9370

Provider Business Practice Location Address
First Line	:	1510 N FANT ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-4708
Country	:	US
Telephone Number	:	864-642-9300
Fax Number	:	864-642-9370

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EDWARD A PINO
Credential	:
Telephone Number	:	864-642-9300

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	04/21/2010

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