| Lakelands Family Practice | |
|
17124 Highway 72 W Waterloo SC 29384-5144 | |
| (864) 819-4900 | |
| (864) 819-3429 |
| Full Name | Lakelands Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 17124 Highway 72 W, Waterloo, South Carolina |
| Authorized Official Name and Position | Lisa Y Gilmer (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 8649418121 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakelands Family Practice 17124 Highway 72 W Waterloo SC 29384-5144 Ph: (864) 819-4900 | Lakelands Family Practice 17124 Highway 72 W Waterloo SC 29384-5144 Ph: (864) 819-4900 |
| NPI Number | 1770616013 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 06/21/2010 |
| Medicare PECOS PAC ID | 5496707804 |
|---|---|
| Medicare Enrollment ID | O20050214000851 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770616013 | NPI | - | NPPES |
| FQC058 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |