Provider Demographics
NPI:1114204153
Name:MCLEOD PHYSICIAN ASSOCIATES II
Entity Type:Organization
Organization Name:MCLEOD PHYSICIAN ASSOCIATES II
Other - Org Name:FAMILY HEALTH CENTER - MT. OLIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANE
Authorized Official - Middle Name:P
Authorized Official - Last Name:FICCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-777-7012
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7010
Mailing Address - Fax:843-777-7006
Practice Address - Street 1:5260 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:GREEN SEA
Practice Address - State:SC
Practice Address - Zip Code:29545-4930
Practice Address - Country:US
Practice Address - Phone:843-392-9222
Practice Address - Fax:843-392-1445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLEOD HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-04
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health