Provider Demographics
NPI:1780643049
Name:LB & KM LLC
Entity Type:Organization
Organization Name:LB & KM LLC
Other - Org Name:THE DOC HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:843-357-1299
Mailing Address - Street 1:PO BOX 2747
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-2662
Mailing Address - Country:US
Mailing Address - Phone:843-357-1299
Mailing Address - Fax:843-357-2264
Practice Address - Street 1:4630 HWY 17 BYPASS
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5016
Practice Address - Country:US
Practice Address - Phone:843-357-1299
Practice Address - Fax:843-357-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDO 411207Q00000X
SCMD17689207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3579Medicaid
SCCK3853OtherRAILROAD MEDICARE
SCGP3579Medicaid