Provider Demographics
NPI:1891726477
Name:MEDICAL ASSOCIATES OF ROCK HILL
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF ROCK HILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:LAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-631-0002
Mailing Address - Street 1:PO BOX 60099
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0099
Mailing Address - Country:US
Mailing Address - Phone:803-328-0181
Mailing Address - Fax:803-328-0553
Practice Address - Street 1:2450 INDIA HOOK RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3270
Practice Address - Country:US
Practice Address - Phone:803-328-0181
Practice Address - Fax:803-328-0553
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL ASSOCIATES OF ROCK HILL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA2096Medicaid
SCPA2096Medicaid