Provider Demographics
NPI:1558356196
Name:B-L FAMILY PRACTICE P A
Entity Type:Organization
Organization Name:B-L FAMILY PRACTICE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CP
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-532-8155
Mailing Address - Street 1:608 E COLUMBIA AVE
Mailing Address - Street 2:PO BOX 3608
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-7318
Mailing Address - Country:US
Mailing Address - Phone:803-532-8155
Mailing Address - Fax:803-532-9685
Practice Address - Street 1:608 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-7318
Practice Address - Country:US
Practice Address - Phone:803-532-8155
Practice Address - Fax:803-532-9685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5713Medicare PIN
SC5059Medicare PIN