| NPI | 1497134852 |
|---|---|
| Doing Business As | MCLEOD PRIMARY CARE BENNETTSVILLE |
| Entity Type | Organization |
| Authorized Contact | DANE P. FICCO Senior Vice President 843-777-7010 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2015-05-19 |