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	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1588388136
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	:	843-777-7120
Fax Number	:	843-777-7102

Provider Business Practice Location Address
First Line	:	690 SUNSET BLVD N STE 208
Second Line	:
City	:	SUNSET BEACH
State	:	NC
Zip	:	28468-5611
Country	:	US
Telephone Number	:	843-366-3715
Fax Number	:	843-366-3716

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

Provider Enumeration Date	:	09/28/2022
Last Update Date	:	11/18/2022

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