Organization
MARION MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAROLD E TUCKER (CHIEF EXECUTIVE OFFICER)
(843) 431-2405
Entity
Organization
Contact information
Practice address
1115 N MAIN ST, MARION, SC 29571-2025
(843) 423-0760
(843) 423-8138
Mailing address
1115 N MAIN ST, MARION, SC 29571-2025
(843) 423-0760
(843) 423-8138
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RHC075
—
SC
Enumeration date
07/10/2006
Last updated
08/16/2010
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