MEDICARE: VICKIE GLOVER PA

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	363A00000X	Physician Assistant	00047961	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P19236	OTHER	SC	MEDICARE

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

General Provider Information

NPI Number	:	1386668648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKIE GLOVER PA

Provider Business Mailing Address
First Line	:	86 WREN STREET
Second Line	:
City	:	BARNWELL
State	:	SC
Zip	:	29812
Country	:	US
Telephone Number	:	803-259-5762
Fax Number	:	803-259-3050

Provider Business Practice Location Address
First Line	:	13649 CHURCH STREET
Second Line	:
City	:	WILLISTON
State	:	SC
Zip	:	29853
Country	:	US
Telephone Number	:	803-266-0060
Fax Number	:	803-266-0042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	01/11/2024

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Directions to “ VICKIE GLOVER PA” Practice Location

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