Provider Demographics
NPI:1053135947
Name:INCLUSIVE MEDICAL PRACTICE SERVICES
Entity type:Organization
Organization Name:INCLUSIVE MEDICAL PRACTICE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:864-941-2748
Mailing Address - Street 1:110 WAYLINE CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-6451
Mailing Address - Country:US
Mailing Address - Phone:864-941-2748
Mailing Address - Fax:
Practice Address - Street 1:405 PARKER IVEY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6513
Practice Address - Country:US
Practice Address - Phone:864-362-4819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service