Provider Demographics
NPI:1700160157
Name:MACKEY FAMILY PRACTICE, PA
Entity Type:Organization
Organization Name:MACKEY FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:M D
Authorized Official - Phone:803-285-7414
Mailing Address - Street 1:8351 CHARLOTTE HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-6552
Mailing Address - Country:US
Mailing Address - Phone:803-396-5368
Mailing Address - Fax:803-396-5350
Practice Address - Street 1:8351 CHARLOTTE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-6552
Practice Address - Country:US
Practice Address - Phone:803-396-5368
Practice Address - Fax:803-396-5350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MACKEY FAMILY PRACTICE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-04
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC211Medicaid
SC423876Medicare PIN