Organization
MCLEOD HEALTH CLARENDON
Active
Other names
McLeod Family Medicine-Kingstree
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL FULTON ERVIN III (SR VICE PRESIDENT AND CFO)
(843) 777-2910
Entity
Organization
Contact information
Practice address
512 NELSON BLVD STE 200, KINGSTREE, SC 29556-4027
(843) 355-5459
Mailing address
PO BOX 100567, FLORENCE, SC 29502-0567
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42-3857
PTAN
SC
Enumeration date
08/09/2019
Last updated
08/09/2019
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