Live Oak Medical Center, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

9352 Issued in SC

Legal business name

LIVE OAK MEDICAL CENTER, PA

Practice address

148 Sauls St.
Lake City, SC 29560

Phone

(843) 687-0435

Fax

(843) 374-3624

NPI assigned

May 20, 2009

Organization subpart

No

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) 374-3621

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1242777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263945600000",
    "number": "1659506699",
    "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": "843-374-3621",
            "fax_number": "843-374-3624"
        },
        {
            "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",
            "fax_number": "843-374-3624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE OAK MEDICAL CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-20",
        "last_updated": "2010-01-20",
        "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": "843-374-3621",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "9352",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5322",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela Lewis, FNP-C
• Sharon Lewis
• Lifeline Regional Ambulance, Inc.
• Live Oak Medical Center
• Live Oak Medical Center, PA
• April Shawn Lockamy, FNP
• Loving Incare Agency
• Karon K. Lowder, LPN
• Lower Florence County Hospital (Palmetto Primary Care)
• Lower Florence County Hospital (Pee Dee Family Practice Lake City)

• Family Medicine Physician in Lake City, SC
• Providers in Lake City, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.