Provider Demographics
NPI:1477590594
Name:BUSSE, CHARLES PETER (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:PETER
Last Name:BUSSE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:AGAPE SENIOR PRIMARY CARE INC
Mailing Address - Street 2:1053 CENTER STREET
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-6749
Mailing Address - Country:US
Mailing Address - Phone:803-726-2350
Mailing Address - Fax:803-753-9102
Practice Address - Street 1:AGAPE SENIOR PRIMARY CARE INC DBA SC HOUSE CALLS
Practice Address - Street 2:1400 MAIN STREET
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526
Practice Address - Country:US
Practice Address - Phone:843-488-0101
Practice Address - Fax:843-488-3130
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2019-01-02
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Provider Licenses
StateLicense IDTaxonomies
SC15009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLL0292Medicaid