Organization
CENTA MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANE M. ALBRIGHT (CREDENTIALING)
(803) 520-5448
Entity
Organization
Contact information
Practice address
157 CORLEY MILL RD, LEXINGTON, SC 29072
(803) 256-2483
(803) 799-4624
Mailing address
157 CORLEY MILL RD, LEXINGTON, SC 29072
(803) 256-2483
(803) 799-4624
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC6996
RAILROAD MEDICARE
—
01
—
GP4644
MEDICAID AUDIOLOGY GRP NUMBER
SC
05
—
PA1382
—
SC
Enumeration date
07/07/2006
Last updated
07/21/2014
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