Provider Demographics
NPI:1063408979
Name:MT PLEASANT FAMILY PRACTICE,PA
Entity type:Organization
Organization Name:MT PLEASANT FAMILY PRACTICE,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-884-1341
Mailing Address - Street 1:900 BOWMAN RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3203
Mailing Address - Country:US
Mailing Address - Phone:843-884-1341
Mailing Address - Fax:843-884-1345
Practice Address - Street 1:900 BOWMAN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3203
Practice Address - Country:US
Practice Address - Phone:843-884-1341
Practice Address - Fax:843-884-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty