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NPI Code Detail

MEDICARE: FAMILY PRACTICE CLINIC OF BOILING SPRINGS

MEDICARE: FAMILY PRACTICE CLINIC OF BOILING SPRINGS
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
1207Q00000XFamily Medicine Physician072469SC

General Provider Information

NPI Number : 1356545768
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY PRACTICE CLINIC OF BOILING SPRINGS
Provider Business Mailing Address
First Line : 2224 OLD FURNACE RD
Second Line :
City : SPARTANBURG
State : SC
Zip : 29316-5782
Country : US
Telephone Number : 864-578-8720
Fax Number :
Provider Business Practice Location Address
First Line : 2224 OLD FURNACE RD
Second Line :
City : SPARTANBURG
State : SC
Zip : 29316-5782
Country : US
Telephone Number : 864-578-8720
Fax Number :
Authorized Official
Title or Position : DR.
Name : DR. ROGER DALE SHEALY
Credential :
Telephone Number : 864-578-8720
Provider Enumeration Date : 06/12/2007
Last Update Date : 08/22/2020

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Directions to “FAMILY PRACTICE CLINIC OF BOILING SPRINGS ” Practice Location

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