Kingstree Family Medicine PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

11529 Issued in SC

Legal business name

KINGSTREE FAMILY MEDICINE PA

Practice address

512 Nelson Blvd
Suite 200
Kingstree, SC 29556-4027

Phone

(843) 355-5459

Fax

(843) 355-9704

NPI assigned

Sep 22, 2005

Last updated

Jun 3, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Raymond Keels Allen, MDNPI 1932192192

Title

President

Phone

(843) 355-5459

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Raymond K Allen, MD

  • Family Medicine Physician
  • Kingstree, SC
  • NPI 1932192192
  NPD Authorized official

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212451200000",
    "number": "1841286192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 NELSON BLVD",
            "address_2": "SUITE 200",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295564027",
            "telephone_number": "843-355-5459",
            "fax_number": "843-355-9704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 NELSON BLVD",
            "address_2": "SUITE 200",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295564027",
            "telephone_number": "843-355-5459",
            "fax_number": "843-355-9704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSTREE FAMILY MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2008-06-03",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "KEELS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-355-5459",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "11529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0509",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Leann Jordan, DMD
• Sarah Ann Justice, RPH
• Cheryl S Kellahan, RN
• Meredith Kellahan
• Kingstree Family Dentisry LLC
• Kingstree Smiles
• Kingstree Surgical Associates
• Lake City Family Medicine (Family Medicine Asociates)
• Lake City Family Medicine, LLC (Family Medicine Associates, LLC)
• Jennifer Moore Lamb, RN, BSN

• Family Medicine Physician in Kingstree, SC
• Providers in Kingstree, 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 Jun 3, 2008; 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.