MEDICARE: SIMPSONVILLE FAMILY MEDICINE, PA

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
2	207Q00000X	Family Medicine Physician	16070	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	1861430720	OTHER	SC	IND. NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1043244023	OTHER	SC	IND NPI
5	1184662033	OTHER	SC	IND NPI

General Provider Information

NPI Number	:	1770586968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPSONVILLE FAMILY MEDICINE, PA

Provider Business Mailing Address
First Line	:	1336 HIGHWAY 14
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681
Country	:	US
Telephone Number	:	864-527-8600
Fax Number	:	864-527-8638

Provider Business Practice Location Address
First Line	:	1336 HIGHWAY 14
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681
Country	:	US
Telephone Number	:	864-527-8600
Fax Number	:	864-527-8638

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	DAWN M BATES
Credential	:
Telephone Number	:	864-527-8600

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2016

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