Provider Demographics
NPI:1033180542
Name:GOLDEN CORNER INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:GOLDEN CORNER INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-882-8890
Mailing Address - Street 1:107 E NORTH 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-3240
Mailing Address - Country:US
Mailing Address - Phone:864-882-8890
Mailing Address - Fax:864-888-1000
Practice Address - Street 1:107 E NORTH 1ST ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-3240
Practice Address - Country:US
Practice Address - Phone:864-882-8890
Practice Address - Fax:864-888-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC189726Medicaid
SC189726Medicaid