Provider Demographics
NPI:1588825616
Name:LANCASTER CLINIC CORP
Entity Type:Organization
Organization Name:LANCASTER CLINIC CORP
Other - Org Name:PALMETTO FAMILY MEDICINE OF KERSHAW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9813
Mailing Address - Street 1:206 SOUTH MATSON ST
Mailing Address - Street 2:
Mailing Address - City:KERSHAW
Mailing Address - State:SC
Mailing Address - Zip Code:29067-1506
Mailing Address - Country:US
Mailing Address - Phone:803-475-1156
Mailing Address - Fax:803-475-1128
Practice Address - Street 1:206 SOUTH MATSON ST
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-1506
Practice Address - Country:US
Practice Address - Phone:803-475-1156
Practice Address - Fax:803-475-1128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANCASTER CLINIC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-20
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC191Medicaid
SC423805Medicare Oscar/Certification