Provider Demographics
NPI:1831140094
Name:NEWBERRY FAMILY HEATLH CENTER
Entity Type:Organization
Organization Name:NEWBERRY FAMILY HEATLH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPC CMC
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOWD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-405-1900
Mailing Address - Street 1:2605 KINARD STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2911
Mailing Address - Country:US
Mailing Address - Phone:803-405-1900
Mailing Address - Fax:803-405-1919
Practice Address - Street 1:99 N MILL ST
Practice Address - Street 2:
Practice Address - City:LITTLE MOUNTAIN
Practice Address - State:SC
Practice Address - Zip Code:29075-8788
Practice Address - Country:US
Practice Address - Phone:803-945-1005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1844Medicaid
SCGP1844Medicaid