Provider Demographics
NPI:1649389511
Name:FLORENCE INTERNAL MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:FLORENCE INTERNAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:W.
Authorized Official - Middle Name:FREEMAN
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-665-2246
Mailing Address - Street 1:2145A HOFFMEYER RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4015
Mailing Address - Country:US
Mailing Address - Phone:843-665-2246
Mailing Address - Fax:843-665-2288
Practice Address - Street 1:2145A HOFFMEYER RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4015
Practice Address - Country:US
Practice Address - Phone:843-665-2246
Practice Address - Fax:843-665-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC04470207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC044703Medicaid
SC247467331OtherBCBS
SCCM5066OtherRAILROAD MEDICARE