Provider Demographics
NPI:1770647927
Name:SENECA FAMILY PRACTICE, PA
Entity Type:Organization
Organization Name:SENECA FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-882-7400
Mailing Address - Street 1:867 WHITWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-9435
Mailing Address - Country:US
Mailing Address - Phone:864-882-7400
Mailing Address - Fax:864-882-7401
Practice Address - Street 1:867 WHITWORTH CIR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9435
Practice Address - Country:US
Practice Address - Phone:864-882-7400
Practice Address - Fax:864-882-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC150OtherMEDICAID RURAL HEALTH
SCRHC150OtherMEDICAID RURAL HEALTH