| Lyons Heart Primary Care LLC | |
|
7623 Wilson Blvd Columbia SC 29203 | |
| (844) 759-6647 | |
| Not Available |
| Full Name | Lyons Heart Primary Care LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 7623 Wilson Blvd, Columbia, South Carolina |
| Authorized Official Name and Position | Sherri Latosha Mccain (OWNER) |
| Authorized Official Contact | 8447596647 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lyons Heart Primary Care LLC 7623 Wilson Blvd Columbia SC 29203-4385 Ph: (844) 759-6647 | Lyons Heart Primary Care LLC 7623 Wilson Blvd Columbia SC 29203 Ph: (844) 759-6647 |
| NPI Number | 1497490676 |
|---|---|
| Provider Enumeration Date | 05/02/2022 |
| Last Update Date | 07/14/2025 |
| Certification Date | 07/10/2025 |
| Medicare PECOS PAC ID | 1456720127 |
|---|---|
| Medicare Enrollment ID | O20221220001552 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497490676 | NPI | - | NPPES |
| 1730558677 | Other | NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| 363LF0000X | Nurse Practitioner - Family | () | Secondary |
| Provider Name | Sherri L Mccain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730558677 PECOS PAC ID: 0446550271 Enrollment ID: I20151201002219 |
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