LIFE CENTER FAMILY MEDICINE LLC

Provider Demographics

• NPI: 1356618920
• Name: LIFE CENTER FAMILY MEDICINE LLC
• Entity type: Organization
• Organization Name: LIFE CENTER FAMILY MEDICINE LLC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: MEDICAL DIRECTOR, CEO
• Authorized Official - Prefix: DR
• Authorized Official - First Name: DANA
• Authorized Official - Middle Name: L
• Authorized Official - Last Name: SIMPSON
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 843-261-2600
• Mailing Address - Street 1: 679 ORANGEBURG RD
• Mailing Address - Street 2: SUITE F
• Mailing Address - City: SUMMERVILLE
• Mailing Address - State: SC
• Mailing Address - Zip Code: 29483-8914
• Mailing Address - Country: US
• Mailing Address - Phone: 843-261-2600
• Mailing Address - Fax: 888-839-6837
• Practice Address - Street 1: 679 ORANGEBURG RD
• Practice Address - Street 2: SUITE F
• Practice Address - City: SUMMERVILLE
• Practice Address - State: SC
• Practice Address - Zip Code: 29483-8914
• Practice Address - Country: US
• Practice Address - Phone: 843-261-2600
• Practice Address - Fax: 888-839-6837
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2011-11-25
• Last Update Date: 2011-11-25

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Single Specialty