NPIMap

Organization Active NPI

Lake City Family Medicine

  • Primary Care Clinic/Center
  • Kingstree, SC
National Provider Identifier
1487164679
Registry record updated Oct 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
LAKE CITY FAMILY MEDICINE
Practice address
505 Thurgood Marshall Hwy
Kingstree, SC 29556-4107
Phone
(843) 355-8380
NPI assigned
Oct 3, 2017
Organization subpart
Yes
Parent organization
LAKE CITY FAMILY MEDICINEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 3, 2017

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

Authorized official

Name
Morris E BrownNPI 1801992599
Title
Medical Director
Phone
(843) 374-8380

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

505 Thurgood Marshall Hwy
Kingstree, SC 29556-4107

Mailing address

505 Thurgood Marshall Hwy
Kingstree, SC 29556-4107

Other identifiers 1

IdentifierTypeStateIssuer
1831445998MedicaidSC

Other names 1

  • Family Medicine Asociates Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lake City Family Medicine3 organizations share this tax ID, including this one
Part of
Lake City Family Medicine

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1506988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506988800000",
    "number": "1487164679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 THURGOOD MARSHALL HWY",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295564107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 THURGOOD MARSHALL HWY",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295564107",
            "telephone_number": "843-355-8380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CITY FAMILY MEDICINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE CITY FAMILY MEDICINE",
        "enumeration_date": "2017-10-03",
        "last_updated": "2017-10-03",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MORRIS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "843-374-8380"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831445998",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine Asociates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingstree, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2017; 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.