Organization
ROSA CLARK MEDICAL CENTER
Active
Other names
Rosa Clark Medical Clinic Association, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE SHANNON LEE (CHIEF FINANCIAL OFFICER)
(864) 614-5617
Entity
Organization
Contact information
Practice address
301 MEMORIAL DR, SENECA, SC 29672
(864) 882-4629
(864) 882-4478
Mailing address
301 MEMORIAL DR, SENECA, SC 29672-9491
(864) 614-5617
(864) 882-4478
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
3129
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125083
PK
—
Enumeration date
01/31/2007
Last updated
11/03/2023
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