Provider Demographics
NPI:1124079645
Name:LOWCOUNTRY MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:LOWCOUNTRY MEDICAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-937-8101
Mailing Address - Street 1:2270 ASHLEY CROSSING DR
Mailing Address - Street 2:SUITE 165
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5732
Mailing Address - Country:US
Mailing Address - Phone:843-763-9472
Mailing Address - Fax:
Practice Address - Street 1:2270 ASHLEY CROSSING DR
Practice Address - Street 2:SUITE 165
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5732
Practice Address - Country:US
Practice Address - Phone:843-763-9472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOWCOUNTRY MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3111Medicaid
SCGP3111Medicaid
SCCK6151Medicare ID - Type UnspecifiedRR MEDICARE GROUP IDENTIF