Provider Demographics
NPI:1891834420
Name:MACKEY FAMILY PRACTICE, PA
Entity Type:Organization
Organization Name:MACKEY FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHEALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-285-7414
Mailing Address - Street 1:1025 W MEETING ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2204
Mailing Address - Country:US
Mailing Address - Phone:803-285-7414
Mailing Address - Fax:803-283-4329
Practice Address - Street 1:1025 W MEETING ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2204
Practice Address - Country:US
Practice Address - Phone:803-285-7414
Practice Address - Fax:803-283-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC127Medicaid
SC428960Medicare PIN
SC428960Medicare ID - Type UnspecifiedRURAL