MEDICARE: INFINITE WELLNESS OF ROCK HILL 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	MD26568	SC

General Provider Information

NPI Number	:	1902284631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITE WELLNESS OF ROCK HILL LLC

Provider Business Mailing Address
First Line	:	739 GALLERIA BLVD
Second Line	:	SUITE 112
City	:	ROCK HILL
State	:	SC
Zip	:	29730-7818
Country	:	US
Telephone Number	:	803-547-4343
Fax Number	:	803-547-3914

Provider Business Practice Location Address
First Line	:	739 GALLERIA BLVD
Second Line	:	SUITE 112
City	:	ROCK HILL
State	:	SC
Zip	:	29730-7818
Country	:	US
Telephone Number	:	803-547-4343
Fax Number	:	803-547-3914

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RICHARD S SCHAFFER JR.
Credential	:	MD
Telephone Number	:	803-547-4343

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	08/20/2015

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