| Lake City Medical Associates 2017, Llc | |
|
130 S Acline St Lake City SC 29560-2633 | |
| (843) 374-3277 | |
| (843) 374-3281 |
| Full Name | Lake City Medical Associates 2017, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 130 S Acline St, Lake City, South Carolina |
| Authorized Official Name and Position | Sheila P Godwin (OFFICE MANAGER) |
| Authorized Official Contact | 8433743277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake City Medical Associates 2017, Llc 130 S Acline St Lake City SC 29560-2633 Ph: () - | Lake City Medical Associates 2017, Llc 130 S Acline St Lake City SC 29560-2633 Ph: (843) 374-3277 |
| NPI Number | 1316477060 |
|---|---|
| Provider Enumeration Date | 06/15/2017 |
| Last Update Date | 03/02/2018 |
| Medicare PECOS PAC ID | 4789957283 |
|---|---|
| Medicare Enrollment ID | O20170905003055 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316477060 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | David Carlos Rodriguez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952399222 PECOS PAC ID: 8921008806 Enrollment ID: I20061227000005 |
| Provider Name | Jessica M Grimsley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255799631 PECOS PAC ID: 5799075958 Enrollment ID: I20160601000900 |
Musc Health Primary Care - Ron Mcnair Blvd Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 276 N Ron Mcnair Blvd, Lake City, SC 29560 Phone: 843-792-1414 | |
Palmetto Primary Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 330 Mercy St, Lake City, SC 29560 Phone: 843-374-9355 Fax: 843-374-9358 | |
East Main Medical Services, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 238 E Main St, Lake City, SC 29560 Phone: 843-374-7020 Fax: 843-374-7021 | |
Hopehealth School Base Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 652 N Matthews Rd, Lake City, SC 29560 Phone: 843-667-9414 Fax: 843-374-2713 | |
Carolinas Medical Alliance Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 John St, Lake City, SC 29560 Phone: 843-394-2031 | |
Live Oak Medical Center, Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 148 Sauls St., Lake City, SC 29560 Phone: 843-687-0435 | |
Lake City Family Medicine Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 901 N Matthews Rd, Lake City, SC 29560 Phone: 843-374-8380 Fax: 843-374-5247 |