Provider Demographics
NPI:1992910210
Name:OCONEE PHYSICIAN PRACTICES
Entity type:Organization
Organization Name:OCONEE PHYSICIAN PRACTICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-885-7191
Mailing Address - Street 1:PO BOX 601082
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1082
Mailing Address - Country:US
Mailing Address - Phone:864-885-7633
Mailing Address - Fax:864-885-7867
Practice Address - Street 1:301 MEMORIAL DR
Practice Address - Street 2:SUITE G
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9491
Practice Address - Country:US
Practice Address - Phone:864-885-7633
Practice Address - Fax:864-885-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4697Medicaid
SC8768Medicare PIN