CAROLINA HEALTH CENTERS, INC. (NPI# 1770616013) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770616013 |
| Entity Type | Organization |
| Organization Name | CAROLINA HEALTH CENTERS, INC. |
| Other Organization Name | LAKELANDS FAMILY PRACTICE |
| Practice Address |
17124 Highway 72 W Waterloo SC 29384-5144 |
| Practice Telephone | 8648194900 |
| Practice Fax Number | 8648193429 |
| Mailing Telephone | 8648194900 |
| Mailing Fax Number | 8648193429 |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2010-06-21 |
| Authorized Official Name | MRS. LISA Y GILMER (PRACTICE ADMINISTRATOR) |
| Authorized Official Telephone | 8649418121 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | FQC058 | 05 |
| Other Name | Type Code |
|---|---|
| Lakelands Family Practice | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518338698 | Carolina Health Centers, Inc. | Clinic/Center | 420 Epting Ave # B, Greenwood, SC 29646-4040 | 2015-10-14 |
| 1720495732 | Carolina Health Centers, Inc. | Clinic/Center | 6977 Sc Highway 28 S, Mc Cormick, SC 29835-7649 | 2014-07-22 |
| 1538428198 | Carolina Health Centers, Inc. | Clinic/Center | 924 Bypass 25 Ne, Greenwood, SC 29649-2900 | 2012-05-16 |
| 1518238690 | Carolina Health Centers, Inc. | Clinic/Center | 700 Plaza Cir Ste B, Clinton, SC 29325-7556 | 2012-01-20 |
| 1912131871 | Carolina Health Centers, Inc. | Pharmacy | 577 Bypass Hwy 72 Nw, Greenwood, SC 29649 | 2009-05-07 |
| 1871626259 | Carolina Health Centers, Inc. | Family Medicine | 535 Jackson St, Calhoun Falls, SC 29628-1222 | 2007-03-14 |
| 1306979521 | Carolina Health Centers, Inc. | Clinic/Center | 313 Main St Ste B, Greenwood, SC 29646-2757 | 2007-03-14 |
| 1639202922 | Carolina Health Centers, Inc. | Clinic/Center | 85 S Greenwood Ave, Ware Shoals, SC 29692-1534 | 2007-03-14 |
| 1063545119 | Carolina Health Centers, Inc. | Clinic/Center | 219a North Mine Street, Mccormick, SC 29835 | 2007-03-14 |
| 1538127352 | Carolina Health Centers, Inc. | Family Medicine | 201 Aiken Rd., Ridge Spring, SC 29129 | 2006-05-02 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CAROLINA HEALTH CENTERS, INC. | 313 Main St, Greenwood, SC 29646-2757 |
| Street Address |
17124 HIGHWAY 72 W |
| City | WATERLOO |
| State | SC |
| Zip Code | 29384-5144 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538397658 | Elcy Zimik | Family Medicine | 17124 Highway 72 W, Waterloo, SC 29384-5144 | 2009-06-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306932900 | Ronald Creswell Taylor | Counselor | 292 Lake Field Rd, Waterloo, SC 29384-0292 | 2006-10-04 |
| 1396046363 | Amanda Holman Smith | Occupational Therapist | 312 Relax St, Waterloo, SC 29384-3503 | 2010-11-08 |
| 1336683192 | Christine A Statom | Licensed Practical Nurse | 10457 Highway 221 S, Waterloo, SC 29384-3910 | 2016-12-14 |
| 1417140351 | Jennifer Ann Reynolds | Respiratory Therapist, Certified | 95 Driftwood Ln, Waterloo, SC 29384-4851 | 2007-08-23 |
| 1639452899 | Jane Workman Ivey | Pharmacist | 363 Ridgewood Dr, Waterloo, SC 29384-5011 | 2011-09-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891395448 | Amanda Hurtt | Pharmacist | 961 N Market St Stop 1, Waterloo, IL 62298-1061 | 2020-10-31 |
| 1679173967 | Tina Marie Moore | Adult Companion | 347 Covington Dr Ste A, Waterloo, IL 62298-3287 | 2020-10-27 |
| 1588261705 | Mobile Therapy Centers of Iowa LLC | Behavioral Analyst | 3520 Inverness Rd, Waterloo, IA 50701-4634 | 2020-10-01 |
| 1942817218 | Fresenius Medical Care Ottumwa, LLC | Clinic/Center | 1655 E San Marnan Dr Ste E, Waterloo, IA 50702-4380 | 2020-09-30 |
| 1629684709 | Peoples Community Health Clinic, Inc | Clinic/Center | 425 1/2 East Ridgeway Ave., Waterloo, IA 50702 | 2020-09-23 |
| 1659986438 | Melissa Anne Stenberg | Registered Nurse | 65 Center St, Waterloo, NY 13165-1024 | 2020-09-09 |
| 1508471418 | Waterloo Urgent Care Walk In Clinic Company | Clinic/Center | 901 Illinois Route 3, Waterloo, IL 62298 | 2020-09-09 |
| 1568076594 | Michelle Ann Tsatsos | Speech-Language Pathologist | 24918 Mason St, Waterloo, NE 68069-4434 | 2020-09-08 |
| 1174137061 | Kristina Gates | Registered Nurse | 604 Lafayette St Ste 202, Waterloo, IA 50703-4708 | 2020-09-08 |
| 1528672904 | Emily Banzer Jensen | Speech-Language Pathologist | 71 Inslee St, Waterloo, NY 13165-1531 | 2020-09-03 |
| Find all providers in WATERLOO | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346867439 | Kinza Ali | Family Medicine | 2055 Kimball Avenue, Suite 101, Waterloo, IA 50702 | 2020-07-06 |
| 1033777610 | Emily Rose Pursley | Family Medicine | Medical Arts Bldg., 2055 Kimball Ave. Suite 101, Waterloo, IA 50702-5070 | 2019-05-30 |
| 1609434281 | Shalini Chowdavarapu | Family Medicine | Ne Ia Family Practice Center, 2055 Kimball Ave. Ste. 101, Waterloo, IA 50702-5070 | 2019-05-30 |
| 1073176533 | Sandeep Badyal | Family Medicine | Ne Ia Family Medicine Residency Program, 2055 Kimball Ave. Ste. 101, Waterloo, IA 50702 | 2019-04-19 |
| 1619530763 | Sophia Tariq Qureshi | Family Medicine | Ne Ia Medical Education Foundation, 2055 Kimball Ave. Ste. 101, Waterloo, IA 50702 | 2019-04-15 |
| 1669826640 | Sapna Patel | Family Medicine | 2140 Logan Ave Ste C, Waterloo, IA 50703-1002 | 2016-04-15 |
| 1174752802 | Lane A Noble | Family Medicine | 2055 Kimball Ave Ste 100, Waterloo, IA 50702-5014 | 2009-07-01 |
| 1568698389 | Michelle Sarah Craig | Family Medicine | 2710 St. Francis Drive, Suite 210, Waterloo, IA 50702-5401 | 2009-06-08 |
| 1386879724 | Lydia Mustafic | Family Medicine | 2710 Saint Francis Dr Ste 210, Waterloo, IA 50702-5664 | 2009-05-28 |
| 1386651560 | David Robert Kobliska | Family Medicine | 2710 St.francis Dr, Waterloo, IA 50702-2081 | 2006-08-01 |
| Find all providers in WATERLOO | ||||
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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.