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	363LA2200X	Adult Health Nurse Practitioner
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1508874488
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	:	843-777-2564
Fax Number	:	843-777-5135

Provider Business Practice Location Address
First Line	:	1203 E CHEVES ST
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29506-2711
Country	:	US
Telephone Number	:	843-777-2564
Fax Number	:	843-777-5135

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	03/27/2009

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