Provider Demographics
NPI:1689004376
Name:PMC PHYSICIAN NETWORK, L.L.C.
Entity Type:Organization
Organization Name:PMC PHYSICIAN NETWORK, L.L.C.
Other - Org Name:FORT MILL FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-265-5009
Mailing Address - Street 1:1690 HIGHWAY 160 W
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8024
Mailing Address - Country:US
Mailing Address - Phone:803-547-7541
Mailing Address - Fax:803-548-0122
Practice Address - Street 1:1690 HIGHWAY 160 W
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8024
Practice Address - Country:US
Practice Address - Phone:803-547-7541
Practice Address - Fax:803-548-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty