Provider Demographics
NPI:1588622120
Name:NEWBERRY FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:NEWBERRY FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR/REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LAPRISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-405-1900
Mailing Address - Street 1:1830 PONDFIELD RD
Mailing Address - Street 2:STE A
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-6499
Mailing Address - Country:US
Mailing Address - Phone:803-405-1900
Mailing Address - Fax:803-405-1919
Practice Address - Street 1:1830 PONDFIELD RD
Practice Address - Street 2:STE A
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-6499
Practice Address - Country:US
Practice Address - Phone:803-405-1900
Practice Address - Fax:803-405-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC428977Medicare ID - Type UnspecifiedRHC MCR PROV ID #