Organization
MCLEOD PHYSICIAN ASSOCIATES II
Active
Parent organization
MCLEOD HEALTH
Other names
McLeod Family Medicine - Latta
Organization subpart
Yes
Provider details
NPI number
Legal business name
MCLEOD HEALTH
Authorized official
MR. PAUL PROVENZANO (REGIONAL PRACTICE MANAGER/AVP)
(843) 777-7030
Entity
Organization
Contact information
Practice address
108A EAST MAIN STREET, LATTA, SC 29565-1617
(843) 752-5111
(843) 752-5100
Mailing address
PO BOX 3239, FLORENCE, SC 29502-3239
(843) 752-5111
(843) 752-5100
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
—
GP4874
—
SC
Enumeration date
09/10/2007
Last updated
03/27/2009
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