Provider Demographics
NPI:1386642189
Name:MCIVER, WINSTON JR (MD)
Entity Type:Individual
Prefix:
First Name:WINSTON
Middle Name:
Last Name:MCIVER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 SINGLETON RIDGE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526
Mailing Address - Country:US
Mailing Address - Phone:843-234-4362
Mailing Address - Fax:
Practice Address - Street 1:660 SINGLETON RIDGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526
Practice Address - Country:US
Practice Address - Phone:843-234-4362
Practice Address - Fax:843-234-9057
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT63542Medicaid
SCT63542Medicaid