Provider Demographics
NPI:1528028727
Name:MED CENTRAL HEALTH RESOURCES, INC
Entity Type:Organization
Organization Name:MED CENTRAL HEALTH RESOURCES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:864-261-3022
Mailing Address - Street 1:3424 CLEMSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1357
Mailing Address - Country:US
Mailing Address - Phone:864-261-3022
Mailing Address - Fax:864-224-5990
Practice Address - Street 1:3424 CLEMSON BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1357
Practice Address - Country:US
Practice Address - Phone:864-261-3022
Practice Address - Fax:864-224-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0205Medicaid
SC3477Medicare ID - Type UnspecifiedGROUP NUMBER