Prime Care of the Lower Pee Dee, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

SC 1873 Issued in SC

Legal business name

PRIME CARE OF THE LOWER PEE DEE, LLC

Practice address

263 Kelley St Ste 100
Lake City, SC 29560-2472

Phone

(843) 394-8274

Fax

(843) 394-1604

NPI assigned

Nov 23, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Tyrone Delmar Wallace, DCNPI 1780633420

Title

Owner

Phone

(843) 394-8274

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tyrone D Wallace, DC

  • Chiropractor
  • Lake City, SC
  • NPI 1780633420
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1479859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479859200000",
    "number": "1437692407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 KELLEYST STE 100",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "29560",
            "telephone_number": "843-394-8274",
            "fax_number": "843-394-1604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 KELLEY ST STE 100",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602472",
            "telephone_number": "843-394-8274",
            "fax_number": "843-394-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME CARE OF THE LOWER PEE DEE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-23",
        "last_updated": "2016-11-23",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "TYRONE",
        "authorized_official_middle_name": "DELMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-394-8274",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "SC",
            "license": "SC 1873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CH1873",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Denita Alison Pleasant, PHARMD
• Leslie Poston Floyd
• Lauren Bingham Powell
• Sandra Denise Powell
• Stuart Smith Powell, FNP-C
• Primecare of the Lower Pee Dee LLC
• Pro-Motion Physical Therapy of Florence, SC, LLC
• Quality Life Home Care Agency
• Quality Rides Transportation LLC
• Reading Railroad, LLC

• Multi-Specialty Clinic/Center in Lake City, SC
• Providers in Lake City, SC by specialty
• Multi-Specialty Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.