Provider Demographics
NPI:1467598920
Name:LOWCOUNTRY MEDICAL CARE, LLC
Entity Type:Organization
Organization Name:LOWCOUNTRY MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:MIKKELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-757-5400
Mailing Address - Street 1:PO BOX 2599
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910
Mailing Address - Country:US
Mailing Address - Phone:843-757-5400
Mailing Address - Fax:843-757-2240
Practice Address - Street 1:181 BLUFFTON RD BLDG G101G102
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6221
Practice Address - Country:US
Practice Address - Phone:843-757-5400
Practice Address - Fax:843-757-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080023023OtherRAILROAD MEDICARE PART B
SCGP0137Medicaid
SC84894OtherMEDCOST
SC84894OtherMEDCOST
SCB55094Medicare UPIN