Provider Demographics
NPI:1578581096
Name:THE FAMILY MEDICAL CTR OF CLINTON INC
Entity Type:Organization
Organization Name:THE FAMILY MEDICAL CTR OF CLINTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:HASKILL-STROWD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-938-0080
Mailing Address - Street 1:302 JACOBS HWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-9415
Mailing Address - Country:US
Mailing Address - Phone:864-938-0080
Mailing Address - Fax:864-938-0084
Practice Address - Street 1:302 JACOBS HWY
Practice Address - Street 2:SUITE H
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-9415
Practice Address - Country:US
Practice Address - Phone:864-938-0080
Practice Address - Fax:864-938-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2442Medicaid
G18174Medicare UPIN
6248Medicare PIN