Organization
PINE TREE FAMILY PRACTICE, P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE SAMUEL JOHNSTON M.D. (PHYSICIAN)
(864) 366-9611
Entity
Organization
Contact information
Practice address
901 W GREENWOOD ST, BUILDING 2, ABBEVILLE, SC 29620-5678
(864) 366-9611
(864) 366-8521
Mailing address
PO BOX 1126, ABBEVILLE, SC 29620-1126
(864) 366-9611
(864) 366-8521
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8390
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080172913
RAILROAD MEDICARE
SC
05
—
PC0557
—
SC
Enumeration date
06/28/2007
Last updated
02/21/2011
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