Provider Demographics
NPI:1245805795
Name:MEDCARE EXPRESS - NORTH CHARLESTON LLC
Entity Type:Organization
Organization Name:MEDCARE EXPRESS - NORTH CHARLESTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PRIDEAUX
Authorized Official - Last Name:LAKEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-656-2730
Mailing Address - Street 1:216 CENTERVIEW DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3226
Mailing Address - Country:US
Mailing Address - Phone:615-656-2750
Mailing Address - Fax:
Practice Address - Street 1:3816 HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-5069
Practice Address - Country:US
Practice Address - Phone:843-272-1411
Practice Address - Fax:843-272-2130
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDCARE EXPRESS - NORTH CHARLESTON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care