Provider Demographics
NPI:1700830254
Name:LANCASTER WOMEN'S CENTER,P.A.
Entity Type:Organization
Organization Name:LANCASTER WOMEN'S CENTER,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:TIEDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-286-6922
Mailing Address - Street 1:PO BOX 1897
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29721-1897
Mailing Address - Country:US
Mailing Address - Phone:803-286-6922
Mailing Address - Fax:803-286-4878
Practice Address - Street 1:1370 W MEETING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2222
Practice Address - Country:US
Practice Address - Phone:803-286-6922
Practice Address - Fax:803-286-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27304261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0072Medicaid
SC3197Medicare ID - Type Unspecified