Provider Demographics
NPI:1780658195
Name:MCLEOD PHYSICIAN ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MCLEOD PHYSICIAN ASSOCIATES, INC.
Other - Org Name:MCLEOD FAMILY MEDICINE - MANNING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-777-7030
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7030
Mailing Address - Fax:843-777-7005
Practice Address - Street 1:22 BOZARD ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-2935
Practice Address - Country:US
Practice Address - Phone:803-435-8828
Practice Address - Fax:803-435-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty