Lifesource of North Carolina
Organization Active NPI General Practice Physician · Clinton, SC
NPI 1972861789 · NPPES record last updated May 17, 2022
Key facts
- NPI
- 1972861789
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- Legal business name
- LIFESOURCE OF NORTH CAROLINA
- Practice address
- 939 Springdale Dr
Clinton, SC 29325-7266 - Phone
- (910) 742-9243
- NPI assigned
- Apr 30, 2012
- Organization subpart
- No
Authorized official
- Name
- Peggy L Baddour
- Title
- President/Owner
- Phone
- (910) 777-9165
Other NPIs with the same Medicare PAC ID 8
Practitioners 193
-
April Michelle Bennett, PSY.D.
-
Ishan Bhansaly, M.D.
-
Vivian Breslin, NURSE PRACTITIONER
-
Rachel Burlingame, LPC
-
Candace Dawn Cathcart, LMFT
-
Maher Elharake, M.D.
-
Karen J Fulwood, NP
-
Louis Joseph Gallagher, PH.D.
-
Tasha Lavon Hinson, LISW-CP LCAS-A
-
Elizabeth Ann Hinz, APRN
-
Michael Anthony Jones, FNP-C
-
Melanie McKinstry Morrison, PMHNP-BC
-
Adrian Novit, PHD
-
Ivra Yvette Pace, LPC
-
Cory Anthony Russell, LPCI
-
Deborah Noel Sadek, APRN
-
Laurrinda H Saxon, LPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120801000901 | SC | Part B Supplier - Clinic/Group Practice | 7416132428 |
Receives reassigned benefits from 51 practitioners Practice locations: Clinton, SC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | |||
| Clinical Social Worker |
1041C0700X | |||
| Family Medicine Physician |
207Q00000X | |||
| Psychiatry Physician |
2084P0800X | |||
| General Practice Physician |
208D00000X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
939 Springdale Dr
Clinton, SC 29325-7266
Mailing address
PO Box 538622
Atlanta, GA 30353-8622
Phone (910) 742-9243
Other practice location 1
2101 Dutch Fork Rd
Chapin, SC 29036-7576
Phone (910) 742-9243
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP5917 | Medicaid | SC |
Other providers in Clinton, SC
- Rebecca West Lawrence
- Bryant A Lawson
- Lchcs Dba Wilson and McCormack Surgical Services
- Martha E Ledda
- Lifesource Accountability Inc
- Lifesource Prime Inc
- Sheila Roche Linton
- Isaac Lipe
- Ingrid Llanes
- James A. Loging
All providers in Clinton, SC · General Practice Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.