Provider Demographics
NPI:1255608113
Name:PHYSICIANS HEALTHCARE OF DILLON
Entity type:Organization
Organization Name:PHYSICIANS HEALTHCARE OF DILLON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KEMPER
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:IX
Authorized Official - Credentials:DC
Authorized Official - Phone:843-774-5182
Mailing Address - Street 1:1639 HIGHWAY 301 N
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-1945
Mailing Address - Country:US
Mailing Address - Phone:843-774-5182
Mailing Address - Fax:
Practice Address - Street 1:1639 HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-1945
Practice Address - Country:US
Practice Address - Phone:843-774-5182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T24466Medicare UPIN