Provider Demographics
NPI:1437130861
Name:KERSHAW FAMILY MEDICINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:KERSHAW FAMILY MEDICINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:803-475-3475
Mailing Address - Street 1:216 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:803-475-3475
Mailing Address - Fax:803-475-5360
Practice Address - Street 1:216 E MARION ST
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-1442
Practice Address - Country:US
Practice Address - Phone:803-475-3475
Practice Address - Fax:803-475-5360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3501Medicaid
SCRHC133Medicaid
SCRHC133Medicaid
SCGP3501Medicaid