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Organization Active NPI

McLeod Physician Associates II

Doing business as McLeod Family Medicine Kingstree

  • Rural Health Clinic/Center
  • Kingstree, SC
National Provider Identifier
1275689002
Registry record updated Aug 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
11529 Issued in SC
Legal business name
MCLEOD PHYSICIAN ASSOCIATES II
Doing business as
McLeod Family Medicine Kingstree
Practice address
512 Nelson Blvd Ste 200
Kingstree, SC 29556-4027
Phone
(843) 355-5459
Fax
(843) 355-9704
NPI assigned
Jan 26, 2007
Last updated
Aug 8, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
MCLEOD HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 8, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Samuel Fulton Ervin III
Title
Sr Vice President and Cfo
Phone
(843) 777-2910

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 11529 SC Primary
Medical Physician Assistant 363AM0700X SC
Family Medicine Physician 207Q00000X SC

Addresses

Primary practice location

512 Nelson Blvd Ste 200
Kingstree, SC 29556-4027

Mailing address

PO Box 3239
Florence, SC 29502-3239
Phone (843) 777-7162

Other identifiers 1

IdentifierTypeStateIssuer
RHC047MedicaidSC

Other names 1

  • McLeod Family Medicine Kingstree Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Tax ID family
McLeod Health Clarendon9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Aug 1, 2019 Change of OwnershipThis provider was the seller McLeod Health ClarendonCCN 423466, SC, NPI 1326693953

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565222400000",
    "number": "1275689002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3239",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295023239",
            "telephone_number": "843-777-7162",
            "fax_number": "843-777-7102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 NELSON BLVD STE 200",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295564027",
            "telephone_number": "843-355-5459",
            "fax_number": "843-355-9704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEOD PHYSICIAN ASSOCIATES II",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEOD HEALTH",
        "enumeration_date": "2007-01-26",
        "last_updated": "2019-08-08",
        "status": "A",
        "authorized_official_last_name": "ERVIN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "FULTON",
        "authorized_official_title_or_position": "SR VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "843-777-2910",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SC",
            "license": "11529",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC047",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McLeod Family Medicine Kingstree",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "McLeod Family Medicine Kingstree",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingstree, SC

Sources for this page

Verify at the official NPI Registry.