Provider Demographics
NPI:1922279298
Name:NORTHWOODS INTERNAL MEDICINE
Entity Type:Organization
Organization Name:NORTHWOODS INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:HEPBURN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-572-1946
Mailing Address - Street 1:2179 ASHLEY PHOSPHATE RD STE B
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4180
Mailing Address - Country:US
Mailing Address - Phone:843-572-1946
Mailing Address - Fax:843-572-0855
Practice Address - Street 1:2179 ASHLEY PHOSPHATE RD
Practice Address - Street 2:STE B
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4180
Practice Address - Country:US
Practice Address - Phone:843-572-1946
Practice Address - Fax:843-572-0855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC182796Medicaid
G20469Medicare UPIN