Provider Demographics
NPI:1649470964
Name:CAROLINA FAMILY MEDICINE OF LAURENS COUNTY PA
Entity type:Organization
Organization Name:CAROLINA FAMILY MEDICINE OF LAURENS COUNTY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAGENBUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-938-9690
Mailing Address - Street 1:300 PLAZA CIR STE E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7557
Mailing Address - Country:US
Mailing Address - Phone:864-938-9690
Mailing Address - Fax:864-833-9039
Practice Address - Street 1:300 PLAZA CIR STE E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7557
Practice Address - Country:US
Practice Address - Phone:864-938-9690
Practice Address - Fax:864-833-9039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9103Medicare PIN