Provider Demographics
NPI:1407182371
Name:MCLEOD FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:MCLEOD FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:G
Authorized Official - Last Name:TEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-537-9932
Mailing Address - Street 1:110 DOCTORS DR
Mailing Address - Street 2:STE B2
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-7112
Mailing Address - Country:US
Mailing Address - Phone:843-537-9932
Mailing Address - Fax:843-537-9936
Practice Address - Street 1:110 DOCTORS DR
Practice Address - Street 2:STE B2
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-7112
Practice Address - Country:US
Practice Address - Phone:843-537-9932
Practice Address - Fax:843-537-9936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC157564Medicaid
SCE398270281Medicare PIN
SCE39827Medicare UPIN