Provider Demographics
NPI:1962501791
Name:ACE MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:ACE MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYO
Authorized Official - Middle Name:MARLAR
Authorized Official - Last Name:NWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-325-2236
Mailing Address - Street 1:430 S HERLONG AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9446
Mailing Address - Country:US
Mailing Address - Phone:803-325-2236
Mailing Address - Fax:803-325-2234
Practice Address - Street 1:744 ARDEN LN
Practice Address - Street 2:#100
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3286
Practice Address - Country:US
Practice Address - Phone:803-325-2236
Practice Address - Fax:803-325-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4541Medicaid
SCGP4541Medicaid
SC8615Medicare PIN
SCH98090Medicare UPIN