Provider Demographics
NPI:1184635401
Name:DR. LINDABERRY AT CAROLINA FOREST, PC
Entity Type:Organization
Organization Name:DR. LINDABERRY AT CAROLINA FOREST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:LINDABERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:843-903-9993
Mailing Address - Street 1:108 FINNEGAN CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4205
Mailing Address - Country:US
Mailing Address - Phone:843-903-9993
Mailing Address - Fax:843-903-3356
Practice Address - Street 1:108 FINNEGAN CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4205
Practice Address - Country:US
Practice Address - Phone:843-903-9993
Practice Address - Fax:843-903-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4245Medicaid
SCH543570281Medicare ID - Type UnspecifiedJEFFREY S LINDABERRY DO
SCGP4245Medicaid