Provider Demographics
NPI:1053507509
Name:CONDON MED SERVICES OF CHERAW
Entity Type:Organization
Organization Name:CONDON MED SERVICES OF CHERAW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:843-921-9270
Mailing Address - Street 1:110 DOCTORS DR
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-7112
Mailing Address - Country:US
Mailing Address - Phone:843-921-9270
Mailing Address - Fax:843-921-9271
Practice Address - Street 1:110 DOCTORS DR
Practice Address - Street 2:SUITE A-2
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-7112
Practice Address - Country:US
Practice Address - Phone:843-921-9270
Practice Address - Fax:843-921-9271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL28496207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC284962Medicaid
SC8434Medicare PIN