Provider Demographics
NPI:1285904664
Name:MCLEOD PHYSICIAN ASSOCIATES II
Entity type:Organization
Organization Name:MCLEOD PHYSICIAN ASSOCIATES II
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VP
Authorized Official - Prefix:
Authorized Official - First Name:DANE
Authorized Official - Middle Name:P
Authorized Official - Last Name:FICCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-777-7000
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:843-777-7042
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:3109 CASEY ST
Practice Address - Street 2:SUITE B
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2807
Practice Address - Country:US
Practice Address - Phone:843-756-8090
Practice Address - Fax:843-756-6122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLEOD HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-03
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty