Provider Demographics
NPI:1932113230
Name:FAMILY DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:FAMILY DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-496-7174
Mailing Address - Street 1:922 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29059-2762
Mailing Address - Country:US
Mailing Address - Phone:803-496-7174
Mailing Address - Fax:803-496-7928
Practice Address - Street 1:922 HOLLY ST
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:SC
Practice Address - Zip Code:29059-2762
Practice Address - Country:US
Practice Address - Phone:803-496-7174
Practice Address - Fax:803-496-7928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY DIAGNOSTIC ASSOC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-29
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC011Medicaid
SCL00039Medicaid
SCL00039Medicaid
SC4819Medicare PIN