Basic Information
Provider Information | |||||||||
NPI: | 1518104223 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MEEHAN | ||||||||
FirstName: | PATRICK | ||||||||
MiddleName: | P. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1624 MAIN STREET | ||||||||
Address2: | AGAPE SENIOR PRIMARY CARE, INC. DBA LTC HEALTH SOLUTION | ||||||||
City: | COLUMBIA | ||||||||
State: | SC | ||||||||
PostalCode: | 292012818 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8037262283 | ||||||||
FaxNumber: | 8037539102 | ||||||||
Practice Location | |||||||||
Address1: | 9302 MEDICAL PLAZA DRIVE STE C | ||||||||
Address2: | AGAPE SENIOR PRIMARY CARE, INC. | ||||||||
City: | CHARLESTON | ||||||||
State: | SC | ||||||||
PostalCode: | 294069142 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8004910909 | ||||||||
FaxNumber: | 8433532581 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/16/2009 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TL 24309 | SC | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.