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276 N Ron Mcnair Blvd Lake City SC 29560-2462 | |
| (843) 374-5471 | |
| (843) 374-5315 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 276 N Ron Mcnair Blvd, Lake City, South Carolina |
| Authorized Official Name and Position | Mary C Duke (DIRECTOR OF PFS) |
| Authorized Official Contact | 8433746431 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
276 N Ron Mcnair Blvd Lake City SC 29560-2462 Ph: (843) 374-5471 | 276 N Ron Mcnair Blvd Lake City SC 29560-2462 Ph: (843) 374-5471 |
| NPI Number | 1235330267 |
|---|---|
| Provider Enumeration Date | 05/29/2007 |
| Last Update Date | 05/19/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235330267 | NPI | - | NPPES |
| GP1912 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | GP1912 (South Carolina) | Primary |
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