Provider Demographics
NPI:1740760560
Name:DIRECT ACCESS MD, LLC
Entity Type:Organization
Organization Name:DIRECT ACCESS MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CIANCIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-965-9150
Mailing Address - Street 1:803 N FANT ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5718
Mailing Address - Country:US
Mailing Address - Phone:864-965-9150
Mailing Address - Fax:864-965-9654
Practice Address - Street 1:803 N FANT ST STE 2A
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5718
Practice Address - Country:US
Practice Address - Phone:864-965-9150
Practice Address - Fax:864-965-9654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty