Provider Demographics
NPI:1780052662
Name:ANGELS MEDICAL LLC
Entity type:Organization
Organization Name:ANGELS MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BITTING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-424-5879
Mailing Address - Street 1:PO BOX 16584
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4060
Mailing Address - Country:US
Mailing Address - Phone:803-424-5879
Mailing Address - Fax:
Practice Address - Street 1:718 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3522
Practice Address - Country:US
Practice Address - Phone:803-424-5879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27570208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP7078Medicaid
SCGP7078Medicaid