Provider Demographics
NPI:1215991757
Name:TURBEVILLE MINTER, ELLEN PATRICE T (MD)
Entity type:Individual
Prefix:
First Name:ELLEN PATRICE
Middle Name:T
Last Name:TURBEVILLE MINTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:T
Other - Last Name:MINTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-5065
Mailing Address - Fax:843-662-2474
Practice Address - Street 1:204 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2604
Practice Address - Country:US
Practice Address - Phone:843-777-5065
Practice Address - Fax:843-662-2474
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20790208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC18500OtherEVOLUTIONS
SC207902Medicaid
SC20074878OtherSELECT HEALTH
SC207003OtherMEDCOST
SC6542416OtherCIGNA
SC057OtherBCBS