Provider Demographics
NPI:1558313080
Name:LOWCOUNTRY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:LOWCOUNTRY MEDICAL ASSOCIATES
Other - Org Name:WEST ASHLEY PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-937-8101
Mailing Address - Street 1:2270 ASHLEY CROSSING DR
Mailing Address - Street 2:STE 170
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5732
Mailing Address - Country:US
Mailing Address - Phone:843-763-3700
Mailing Address - Fax:
Practice Address - Street 1:2270 ASHLEY CROSSING DR
Practice Address - Street 2:STE 170
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5732
Practice Address - Country:US
Practice Address - Phone:843-763-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207R00000X, 208000000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1157Medicaid
SCGP1202Medicaid
SCGP1202Medicaid