Provider Demographics
NPI:1083137616
Name:SC MED LLC
Entity type:Organization
Organization Name:SC MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAVANIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-742-2036
Mailing Address - Street 1:10436 WINSLET DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2956
Mailing Address - Country:US
Mailing Address - Phone:702-742-2036
Mailing Address - Fax:
Practice Address - Street 1:10436 WINSLET DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2956
Practice Address - Country:US
Practice Address - Phone:702-742-2036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD40247207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCA2449074OtherMEDICARE