Provider Demographics
NPI:1154510352
Name:CARE-NET OF LANCASTER
Entity Type:Organization
Organization Name:CARE-NET OF LANCASTER
Other - Org Name:PLEXUS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:BARRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-465-3608
Mailing Address - Street 1:212 E MARION ST
Mailing Address - Street 2:
Mailing Address - City:KERSHAW
Mailing Address - State:SC
Mailing Address - Zip Code:29067-1442
Mailing Address - Country:US
Mailing Address - Phone:803-465-3608
Mailing Address - Fax:
Practice Address - Street 1:703 N WHITE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2174
Practice Address - Country:US
Practice Address - Phone:803-285-2273
Practice Address - Fax:803-459-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207Q00000X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC421967OtherMEDICARE PART A
SCFQC145Medicaid
SC8901Medicare PIN