Provider Demographics
NPI:1164620779
Name:LOMAX AND JORDAN ENT
Entity Type:Organization
Organization Name:LOMAX AND JORDAN ENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOMAX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-873-6873
Mailing Address - Street 1:208 E 2ND NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6858
Mailing Address - Country:US
Mailing Address - Phone:843-873-6873
Mailing Address - Fax:843-871-7111
Practice Address - Street 1:208 E 2ND NORTH ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6858
Practice Address - Country:US
Practice Address - Phone:843-873-6873
Practice Address - Fax:843-871-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2960Medicaid
SCGP2960Medicaid
SC7233Medicare PIN