MEDICARE: MCLEOD PHYSICIAN ASSOCIATES II

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1942008685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCLEOD PHYSICIAN ASSOCIATES II

Provider Business Mailing Address
First Line	:	506 E CHEVES ST STE 202
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29506-2616
Country	:	US
Telephone Number	:	843-777-7010
Fax Number	:	843-777-5572

Provider Business Practice Location Address
First Line	:	3617 CASEY ST STE B
Second Line	:
City	:	LORIS
State	:	SC
Zip	:	29569-2981
Country	:	US
Telephone Number	:	843-716-8300
Fax Number	:	843-716-9792

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	KENNETH BEASLEY
Credential	:
Telephone Number	:	843-777-7010

Provider Enumeration Date	:	03/07/2025
Last Update Date	:	02/03/2026

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