NPIMap

Organization Active NPI

Live Oak Medical Center, PA

  • Family Medicine Physician
  • Lake City, SC
National Provider Identifier
1144455197
Registry record updated May 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LIVE OAK MEDICAL CENTER, PA
Practice address
148 Sauls St.
Lake City, SC 29560
Phone
(843) 687-0435
NPI assigned
May 20, 2009
Organization subpart
Yes
Parent organization
LIVE OAK MEDICAL CENTER, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 17, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Albert Durant Mims, M.D.
Title
Director
Phone
(843) 687-0435

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

148 Sauls St.
Lake City, SC 29560

Mailing address

148 Sauls St.
Lake City, SC 29560
Phone (843) 687-0435

National Provider Directory

National Provider Directory
Tax ID family
Live Oak Medical Center PA3 organizations share this tax ID, including this one
Part of
Live Oak Medical Center PA

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274054400000",
    "number": "1144455197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 SAULS ST.",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "29560",
            "telephone_number": "843-687-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 SAULS ST.",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "29560",
            "telephone_number": "843-687-0435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE OAK MEDICAL CENTER, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIVE OAK MEDICAL CENTER, PA",
        "enumeration_date": "2009-05-20",
        "last_updated": "2010-05-17",
        "status": "A",
        "authorized_official_last_name": "MIMS",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "DURANT",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "843-687-0435",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.