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
1	363LF0000X	Family Nurse Practitioner
2	261QR1300X	Rural Health Clinic/Center
3	207Q00000X	Family Medicine 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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437253028
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	:	843-394-1051
Fax Number	:	843-394-0277

Provider Business Practice Location Address
First Line	:	276 N RON MCNAIR BLVD
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-2462
Country	:	US
Telephone Number	:	843-394-1051
Fax Number	:	843-394-0277

Authorized Official
Title or Position	:	REGIONAL PRACTICE MANAGER/AVP
Name	:	JEFF MURRELL
Credential	:
Telephone Number	:	843-777-7093

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	03/27/2009

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