NPIMap

Organization Active NPI

McLeod Physician Associates II

Doing business as McLeod Family Medicine - Latta

  • Family Medicine Physician
  • Latta, SC
National Provider Identifier
1689869018
Registry record updated Mar 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MCLEOD PHYSICIAN ASSOCIATES II
Doing business as
McLeod Family Medicine - Latta
Practice address
108A East Main Street
Latta, SC 29565-1617
Phone
(843) 752-5111
Fax
(843) 752-5100
NPI assigned
Sep 10, 2007
Last updated
Mar 27, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
MCLEOD HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2009

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

Authorized official

Name
Mr. Paul Provenzano
Title
Regional Practice Manager/Avp
Phone
(843) 777-7030

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X
Family Nurse Practitioner 363LF0000X
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

108A East Main Street
Latta, SC 29565-1617

Mailing address

PO Box 3239
Florence, SC 29502-3239
Phone (843) 752-5111

Other identifiers 1

IdentifierTypeStateIssuer
GP4874MedicaidSC

Other names 1

  • McLeod Family Medicine - Latta Doing business as

National Provider Directory

National Provider Directory
Tax ID family
McLeod Physician Assoc II138 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

108A E Main St
Latta, SC 29565
Phone (843) 616-8770

NPI Registry JSON

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

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238112000000",
    "number": "1689869018",
    "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": "843-752-5111",
            "fax_number": "843-752-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108A EAST MAIN STREET",
            "city": "LATTA",
            "state": "SC",
            "postal_code": "295651617",
            "telephone_number": "843-752-5111",
            "fax_number": "843-752-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEOD PHYSICIAN ASSOCIATES II",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEOD HEALTH",
        "enumeration_date": "2007-09-10",
        "last_updated": "2009-03-27",
        "status": "A",
        "authorized_official_last_name": "PROVENZANO",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "REGIONAL PRACTICE MANAGER/AVP",
        "authorized_official_telephone_number": "843-777-7030",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4874",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McLeod Family Medicine - Latta",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Latta, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.