Organization
MCLEOD PHYSICIAN ASSOCIATES II
Active
Parent organization
MCLEOD HEALTH
Other names
McLeod Family Practice - Timmonsville
Organization subpart
Yes
Provider details
NPI number
Legal business name
MCLEOD HEALTH
Authorized official
PAUL PROVENZANO (REGIONAL PRACTICE MANAGER/AVP)
(843) 777-7030
Entity
Organization
Contact information
Practice address
755 E SMITH ST, TIMMONSVILLE, SC 29161-9430
(843) 346-3900
(843) 346-7839
Mailing address
PO BOX 3239, FLORENCE, SC 29502-3239
(843) 346-3900
(843) 346-7839
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP1781
—
SC
05
—
RHC137
—
SC
05
—
RHC170
—
SC
Enumeration date
09/12/2006
Last updated
03/27/2009
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