Provider Demographics
NPI:1578115911
Name:WHOLE HEART FAMILY MEDICINE
Entity Type:Organization
Organization Name:WHOLE HEART FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:843-367-0190
Mailing Address - Street 1:637 OAK MARSH DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5178
Mailing Address - Country:US
Mailing Address - Phone:843-367-0190
Mailing Address - Fax:
Practice Address - Street 1:2891 TRICOM ST STE C
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-7110
Practice Address - Country:US
Practice Address - Phone:843-367-0190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty