Mcleod Family Medicine - Latta

LBN: Mcleod Physician Associates Ii
Mcleod Family Medicine - Latta is an health care organization with primary practice located at 108A East Main Street , Latta SC 29565-1617. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Ambulatory Health Care Facilities / Rural Health, Physician Assistants & Advanced Practice Nursing Providers / Family. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty. Mcleod Physician Associates Ii can be contacted via phone (843) 752-5111, or through Provenzano, Paul via phone (843) 777-7030.

Contact Information

Primary practice address
108A East Main Street Latta SC 29565-1617
Phone: (843) 752-5111
Fax: (843) 752-5100
Website:
Map and Directions
Authorized official contact:
Name: Provenzano, Paul
Phone: (843) 777-7030

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X
Ambulatory Health Care Facilities / Rural Health 261QR1300X
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X

Profile Details

NPI number 1689869018
LBN Legal business name Mcleod Physician Associates Ii
DBA Doing business as Mcleod Family Medicine - Latta
Authorized official Provenzano, Paul
Entity Organization
Organization subpart 1 Yes
Enumeration date Sep 10th, 2007
Last updated Mar 27th, 2009 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689869018 NPPES
South Carolina MEDICAID GP4874

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