Provider Demographics
NPI:1376862284
Name:MCLEOD PHYSICIAN ASSOCIATES II
Entity Type:Organization
Organization Name:MCLEOD PHYSICIAN ASSOCIATES II
Other - Org Name:MCLEOD PEDIATRIC DIABETES CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP/REGIONAL PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MURRELL
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:843-777-5701
Mailing Address - Fax:843-777-7320
Practice Address - Street 1:901 E CHEVES ST
Practice Address - Street 2:SUITE 420
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2716
Practice Address - Country:US
Practice Address - Phone:843-777-5701
Practice Address - Fax:843-777-7320
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLEOD HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23029163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty