Organization
CHESTERFIELD-MARLBORO, LP
Active
Other names
Marlboro Primary Care Associates
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE HOLTSFORD (AUTHORIZED OFFICIAL)
(615) 465-7466
Entity
Organization
Contact information
Practice address
1040 MARLBORO WAY, SUITE 1, BENNETTSVILLE, SC 29512-2494
(843) 479-5890
(843) 479-5893
Mailing address
1040 MARLBORO WAY, SUITE 1, BENNETTSVILLE, SC 29512-2494
(843) 479-5890
(843) 479-5893
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
HTL0677
SC
363L00000X
Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5901801
—
NC
05
—
GP1449
—
SC
Enumeration date
08/09/2006
Last updated
01/21/2014
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