MEDICARE: MINUTECLINIC DIAGNOSTIC SOUTH CAROLINA 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1447420815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINUTECLINIC DIAGNOSTIC SOUTH CAROLINA LLC

Provider Business Mailing Address
First Line	:	PO BOX 772
Second Line	:	MINUTECLINIC CREDENTIALING
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-0784
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:	401-406-3539

Provider Business Practice Location Address
First Line	:	698 FAIRVIEW RD
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29680-6708
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:	401-406-3539

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DEBORAH PINCINCE
Credential	:
Telephone Number	:	401-770-3813

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	06/24/2024

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