Organization
GRACE INTERNAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEON BUFFALOE (PRESIDENT)
(864) 360-8802
Entity
Organization
Contact information
Practice address
114B HOSPITAL DR, SIMPSONVILLE, SC 29681-3226
(803) 757-5177
(803) 757-5178
Mailing address
114B HOSPITAL DR, SIMPSONVILLE, SC 29681-3226
(864) 757-5177
(864) 757-5178
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
08/16/2022
Last updated
09/24/2024
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