Basic Information
| Provider Information | |||||||||
| NPI: | 1861872590 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY HEALTH CENTERS, INC | ||||||||
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| OtherOrganizationName: | ST. MATTHEWS MEDICAL CENTER PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3310 MAGNOLIA ST | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291151466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035316900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 558 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | ST MATTHEWS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291358104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8038742006 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2015 | ||||||||
| LastUpdateDate: | 06/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | BRUNSON | ||||||||
| AuthorizedOfficialFirstName: | LEON | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICEER | ||||||||
| AuthorizedOfficialTelephone: | 8035316900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | SC | Y | Suppliers | Pharmacy | Clinic Pharmacy |
No ID Information.