Provider Demographics
NPI:1275651531
Name:PHYSICIANS HEALTHCARE OF DILLON, P.C.
Entity Type:Organization
Organization Name:PHYSICIANS HEALTHCARE OF DILLON, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:STANTON, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-774-8438
Mailing Address - Street 1:1639 HIGHWAY 301 N
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-1945
Mailing Address - Country:US
Mailing Address - Phone:843-774-8438
Mailing Address - Fax:843-841-0703
Practice Address - Street 1:1639 HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-1945
Practice Address - Country:US
Practice Address - Phone:843-774-8438
Practice Address - Fax:843-841-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC794111N00000X, 261Q00000X
SC159875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGHC 473Medicaid
SCGP4109Medicaid
SCGP4109Medicaid
SCGHC 473Medicaid
SC8066Medicare ID - Type UnspecifiedGROUP #