# PEDIATRIC EVENING CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467438275
- **Authorized official:** DR. RALPH H JOHNS MD (OWNER)
- **Authorized official phone:** (864) 591-0311

## Contact information

- **Practice address:** 451A E SAINT JOHN ST, SPARTANBURG, SC 29302-1623
- **Practice address phone:** (864) 591-0311
- **Practice address fax:** (864) 591-0744
- **Mailing address:** 451A E SAINT JOHN ST, SPARTANBURG, SC 29302-1623
- **Mailing address phone:** (864) 591-0311
- **Mailing address fax:** (864) 591-0744

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QU0200X | Urgent Care Clinic/Center | 17001 | SC | Yes |

## Other

- **Enumeration date:** 12/22/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 170013 | — | SC |