MEDICARE: HARTSVILLE MEDICAL ASSOCIATES 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	32800	SC

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
2	SC12769293	OTHER		PROVIDER PTAN
3	1609197623	OTHER	SC	NPI

General Provider Information

NPI Number	:	1770030926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARTSVILLE MEDICAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	PO BOX 247
Second Line	:
City	:	HARTSVILLE
State	:	SC
Zip	:	29551-0247
Country	:	US
Telephone Number	:	843-917-4117
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 SWIFT CREEK RD
Second Line	:
City	:	HARTSVILLE
State	:	SC
Zip	:	29550-4383
Country	:	US
Telephone Number	:	843-917-4117
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. LUZ YOLANDA MENDEZ
Credential	:	MD
Telephone Number	:	646-683-3793

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	06/13/2017

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