Basic Information
| Provider Information | |||||||||
| NPI: | 1093748386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEMOW | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | BICE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100174 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292023174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645126140 | ||||||||
| FaxNumber: | 8645126149 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 E GREENVILLE ST STE 3700 | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296211725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645121475 | ||||||||
| FaxNumber: | 8645121930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 11/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25032 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 25032 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 250329 | 05 | SC | MEDICAID |