Provider Demographics
NPI:1568555753
Name:FAMILY MEDICINE CENTERS OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:FAMILY MEDICINE CENTERS OF SOUTH CAROLINA
Other - Org Name:SPRINGWOOD LAKE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SERBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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 1:1721 HORSESHOE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6281
Practice Address - Country:US
Practice Address - Phone:803-779-1420
Practice Address - Fax:803-931-0676
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY MECICINE CENTERS OF SOUTH CAROLINA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3424Medicaid
SCGP3424Medicaid