Provider Demographics
NPI:1093764797
Name:SC-SEWEEFAMILY MEDICINE
Entity Type:Organization
Organization Name:SC-SEWEEFAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KNEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:843-884-2133
Mailing Address - Street 1:874 WHIPPLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8900
Mailing Address - Country:US
Mailing Address - Phone:843-884-2133
Mailing Address - Fax:843-849-9466
Practice Address - Street 1:874 WHIPPLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8900
Practice Address - Country:US
Practice Address - Phone:843-884-2133
Practice Address - Fax:843-849-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2711Medicaid
SC6360700001Medicare NSC
SC6645Medicare ID - Type Unspecified