Provider Demographics
NPI:1538467808
Name:FAMILY MEDICINE CENTERS OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:FAMILY MEDICINE CENTERS OF SOUTH CAROLINA
Other - Org Name:LAKE MURRAY FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-779-1420
Mailing Address - Street 1:1910 GREGG ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2618
Mailing Address - Country:US
Mailing Address - Phone:803-779-1420
Mailing Address - Fax:803-931-0676
Practice Address - Street 1:7611 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2834
Practice Address - Country:US
Practice Address - Phone:803-724-1100
Practice Address - Fax:803-724-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care