Organization
ST PAUL'S MEDICAL GROUP, INC
Active
Other names
ST PAULS MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MARSHA GAY DELAVAN PA-C (PRESIDENT)
(843) 889-8018
Entity
Organization
Contact information
Practice address
7610 HIGHWAY 164, HOLLYWOOD, SC 29449
(843) 889-8018
(843) 889-9133
Mailing address
PO BOX 1355, HOLLYWOOD, SC 29449-1355
(843) 889-8018
(843) 889-9133
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42D0968299
CLIA NUMBER
SC
05
—
GP2603
—
SC
Enumeration date
05/03/2007
Last updated
12/28/2009
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