MEDICARE: CAREHERE, LLC

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	MD24062	SC

General Provider Information

NPI Number	:	1710346952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREHERE, LLC

Provider Business Mailing Address
First Line	:	5141 VIRGINIA WAY STE 350
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2319
Country	:	US
Telephone Number	:	615-221-5901
Fax Number	:

Provider Business Practice Location Address
First Line	:	3127 MR JOE WHITE AVE
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-6712
Country	:	US
Telephone Number	:	615-221-5901
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ERNIE CLEVENGER
Credential	:
Telephone Number	:	615-221-5901

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	02/16/2016

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