Organization
CAROLINA LONG TERM CARE ASSOICATES,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH BRYAN HELLER MD (PRESIDENT)
(864) 940-9701
Entity
Organization
Contact information
Practice address
113 WILDWOOD DR, BELTON, SC 29627-9687
(864) 940-9701
(864) 338-8760
Mailing address
PO BOX 846, BELTON, SC 29627-0846
(864) 940-9701
(864) 338-8760
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3289
—
SC
Enumeration date
07/06/2006
Last updated
09/16/2010
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