Basic Information
| Provider Information | |||||||||
| NPI: | 1568502284 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERNAL MEDICINE SPECIALISTS OF FLORENCE,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 S COIT ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295015220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436652191 | ||||||||
| FaxNumber: | 8436790818 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 S COIT ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295015220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436652191 | ||||||||
| FaxNumber: | 8436790818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 05/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | ROSS | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8436652191 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | GP4654 | 05 | SC | MEDICAID | DF6812 | 01 | SC | MEDICARE B RAILROAD | OTHER |