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
1	2080P0203X	Pediatric Critical Care Medicine Physician
2	2080P0205X	Pediatric Endocrinology Physician
3	2080P0206X	Pediatric Gastroenterology Physician
4	363LF0000X	Family Nurse Practitioner
5	2080P0202X	Pediatric Cardiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	=========	OTHER	SC	BLUE CHOICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	=========	OTHER	SC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1598739799
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	:	843-777-7300
Fax Number	:	843-777-7311

Provider Business Practice Location Address
First Line	:	101 WILLIAM H. JOHNSON STREET
Second Line	:	STE. 400
City	:	FLORENCE
State	:	SC
Zip	:	29506-2772
Country	:	US
Telephone Number	:	843-777-7300
Fax Number	:	843-777-7311

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	06/03/2022

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Directions to “MCLEOD PHYSICIAN ASSOCIATES II ” Practice Location

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