Organization
MARLBORO CLINIC CORP
Active
Parent organization
MARLBORO CLINIC CORP
Other names
Marlboro Women's Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARLBORO CLINIC CORP
Authorized official
DEBBIE T BREWER (PROVIDER ENROLLMENT)
(800) 709-7345
Entity
Organization
Contact information
Practice address
1040 MARLBORO WAY, SUITE 8, BENNETTSVILLE, SC 29512-2494
(843) 454-1100
(843) 454-0110
Mailing address
1040 MARLBORO WAY, SUITE 8, BENNETTSVILLE, SC 29512-2494
(843) 454-1100
(843) 454-0110
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57109350004
BCBS
SC
05
—
89016G5
—
NC
05
—
GP3861
—
SC
05
—
GP4559
—
SC
Enumeration date
12/06/2006
Last updated
04/20/2008
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