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	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1467060376
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	:	843-646-8923
Fax Number	:	843-777-7102

Provider Business Practice Location Address
First Line	:	106 LANSFORD PL STE 100
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6979
Country	:	US
Telephone Number	:	843-777-7010
Fax Number	:	843-777-7005

Authorized Official
Title or Position	:	AVP
Name	:	LOGAN SAWYER
Credential	:
Telephone Number	:	843-777-7010

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	07/16/2020

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