Organization
MAIN ST MEDICAL - NEW ELLENTON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY YOUNG HIBBITTS (OWNER)
(803) 646-5036
Entity
Organization
Contact information
Practice address
735 MAIN ST N, NEW ELLENTON, SC 29809-2518
(803) 443-0077
Mailing address
735 MAIN ST N, NEW ELLENTON, SC 29809-2518
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
11/18/2024
Last updated
11/18/2024
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