Provider Demographics
NPI:1326339607
Name:MCLEOD PHYSICIAN ASSOCIATES II
Entity Type:Organization
Organization Name:MCLEOD PHYSICIAN ASSOCIATES II
Other - Org Name:MCLEOD FAMILY MEDICINE WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-777-7000
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:843-777-7122
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:3013 WEST PALMETTO STREET
Practice Address - Street 2:SUITE B
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5935
Practice Address - Country:US
Practice Address - Phone:843-777-7010
Practice Address - Fax:843-777-7006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLEOD HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty