Organization
CHESTERFIELD-MARLBORO, LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(866) 398-7108
Entity
Organization
Contact information
Practice address
711 CHESTERFIELD HWY, CHERAW, SC 29520-7002
(843) 320-3304
(843) 320-3480
Mailing address
711 CHESTERFIELD HWY, CHERAW, SC 29520-7002
(843) 320-3304
(843) 320-3480
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
SC
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400621
—
SC
05
—
89012AV
—
NC
05
—
890769B
—
NC
01
—
CG3996
RR MEDICARE
SC
Enumeration date
05/05/2006
Last updated
10/28/2011
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