MEDICARE: MT PLEASANT FAMILY HEALTH GROUP

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	208D00000X	General Practice Physician	15987	SC
2	111NR0400X	Rehabilitation Chiropractor	1830	SC

General Provider Information

NPI Number	:	1760560601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT PLEASANT FAMILY HEALTH GROUP

Provider Business Mailing Address
First Line	:	1117 PARK WEST BLVD STE D
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-7120
Country	:	US
Telephone Number	:	843-884-6194
Fax Number	:	480-393-4132

Provider Business Practice Location Address
First Line	:	1117 PARK WEST BLVD STE D
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-7120
Country	:	US
Telephone Number	:	843-884-6194
Fax Number	:	480-393-4132

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JOSEPH PATRICK MARKOVICH
Credential	:	DC
Telephone Number	:	843-884-6194

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/11/2025

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