Provider Demographics
NPI:1477880037
Name:LANCASTER CLINIC CORP
Entity Type:Organization
Organization Name:LANCASTER CLINIC CORP
Other - Org Name:LANCASTER PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9813
Mailing Address - Street 1:7100 COMMERCE WAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2829
Mailing Address - Country:US
Mailing Address - Phone:866-398-7108
Mailing Address - Fax:615-465-2875
Practice Address - Street 1:838 W MEETING ST
Practice Address - Street 2:SUITE A
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-6233
Practice Address - Country:US
Practice Address - Phone:803-285-2700
Practice Address - Fax:803-285-2707
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANCASTER CLINIC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health