PRIME CARE OF THE LOWER PEE DEE, LLC (NPI# 1437692407) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437692407 |
| Entity Type | Organization |
| Organization Name | PRIME CARE OF THE LOWER PEE DEE, LLC |
| Practice Address |
263 Kelley St Ste 100 Lake City SC 29560-2472 |
| Mailing Address |
263 Kelleyst Ste 100 Lake City SC 29560 |
| Practice Telephone | 8433948274 |
| Practice Fax Number | 8433941604 |
| Mailing Telephone | 8433948274 |
| Mailing Fax Number | 8433941604 |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2016-11-23 |
| Authorized Official Name | DR. TYRONE DELMAR WALLACE (OWNER) |
| Authorized Official Telephone | 8433948274 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
SC 1873 | SC | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | CH1873 | 05 |
| Street Address |
263 KELLEY ST STE 100 |
| City | LAKE CITY |
| State | SC |
| Zip Code | 29560-2472 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841656527 | Chucky Sentell Jordan | Chiropractor | 263 Kelley St Ste 100, Lake City, SC 29560-2472 | 2016-01-11 |
| 1679170856 | Reginel Simon | Chiropractor | 263 Kelley St Ste 100, Lake City, SC 29560-2472 | 2020-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457830366 | Patty Fulmore | In Home Supportive Care | 141 Bulldog Lane, Lake City, SC 29560 | 2018-08-10 |
| 1558875211 | Msk Transportation | Non-emergency Medical Transport (VAN) | 226 Lake Dale Ave, Lake City, SC 29560 | 2017-11-16 |
| 1861867566 | Denita Alison Pleasant | Pharmacist | 301 West Thomas Street, Lake City, SC 29560 | 2015-12-07 |
| 1821474115 | Pro-motion Physical Therapy of Florence, Sc, LLC | Occupational Therapist | 148 B Sauls Street, Lake City, SC 29560 | 2015-08-10 |
| 1023412335 | Motivations-unlimited | Speech-Language Pathologist | 318 A Moore Street, Lake City, SC 29560 | 2014-10-15 |
| 1700297652 | Sharon Lewis | Pharmacist | 900 Us Highway 52, Lake City, SC 29560 | 2014-05-14 |
| 1376954305 | Sergio Montes | Pharmacist | 900 Us Hwy 52, Lake City, SC 29560 | 2014-05-13 |
| 1992122857 | Paula Moses | Pharmacist | 900 U.s Hwy. 52, Lake City, SC 29560 | 2014-03-27 |
| 1063762763 | Dawn Mcelveen Floyd | Pharmacist | 301 W Thomas Street, Lake City, SC 29560 | 2012-09-11 |
| 1548519507 | Robert Bruce Page | Pharmacist | 401 West Thomas St, Lake City, SC 29560 | 2012-09-06 |
| Find all providers in zip 29560 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497854186 | Shands At Lake Shore Inc | Clinic/Center | 348 Ne Methodist Ter, Suite 101, Lake City, FL 32055-3409 | 2006-09-21 |
| 1871692475 | Shands At Lake Shore Inc | Clinic/Center | 755 Sw State Road 47, Lake City, FL 32025-0453 | 2006-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114551926 | Nocd North Carolina PC | Clinic/Center | 374 Lakewind Dr, Moncks Corner, SC 29461-7448 | 2020-03-02 |
| 1316419484 | Open Arms Counseling Center | Clinic/Center | 123 Erinvine Ct, Darlington, SC 29532-4203 | 2018-12-29 |
| 1750851085 | Jacobus Orthopedics and Interventional Pain Management LLC | Clinic/Center | 118 Clair Dr, Piedmont, SC 29673-7771 | 2018-11-29 |
| 1629556477 | Healthworks Med Group of South Carolina P C | Clinic/Center | 701 Chesterfield Hwy, Cheraw, SC 29520-7002 | 2018-08-03 |
| 1780177576 | Denmark-olar Elementary School | Clinic/Center | 1459 Solomon Blatt Blvd, Denmark, SC 29042 | 2018-06-07 |
| 1841782802 | Denmark-olar High School | Clinic/Center | 197 Viking Cir, Denmark, SC 29042 | 2018-06-05 |
| 1760974828 | Sandy Run K-8 School | Clinic/Center | 450 Old Swamp Rd, Swansea, SC 29160 | 2018-06-05 |
| 1881185999 | St. Matthews K-8 School | Clinic/Center | 132 Saints Avenue, St .matthews, SC 29135 | 2018-05-24 |
| 1598256711 | Calhoun County High School | Clinic/Center | 150 Saints Ave, St Matthews, SC 29135-9005 | 2018-05-23 |
| 1962908558 | Vitality Health Network LLC | Clinic/Center | 3100 Dick Pond Rd Unit E, Myrtle Beach, SC 29588-7286 | 2018-04-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.