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	207RC0000X	Cardiovascular Disease 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

General Provider Information

NPI Number	:	1578865564
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	:	843-777-7133
Fax Number	:	843-777-7102

Provider Business Practice Location Address
First Line	:	540 PHYSICIANS LN
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-3370
Country	:	US
Telephone Number	:	803-883-5171
Fax Number	:	803-305-1814

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	KENNETH D. BEASLEY
Credential	:
Telephone Number	:	843-777-7010

Provider Enumeration Date	:	11/23/2010
Last Update Date	:	06/07/2022

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