MEDICARE: KERSHAW CLINICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207RP1001X	Pulmonary Disease Physician	SC
2	207RG0100X	Gastroenterology Physician	SC
3	207RI0200X	Infectious Disease Physician	SC
4	208600000X	Surgery Physician	SC
5	363LF0000X	Family Nurse Practitioner	SC
6	363L00000X	Nurse Practitioner	SC
7	208M00000X	Hospitalist Physician	SC
8	207Q00000X	Family Medicine Physician	SC

General Provider Information

NPI Number	:	1033593454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERSHAW CLINICS LLC

Provider Business Mailing Address
First Line	:	1165 HIGHWAY 1 S
Second Line	:	SUITE 300
City	:	LUGOFF
State	:	SC
Zip	:	29078-8966
Country	:	US
Telephone Number	:	803-438-0872
Fax Number	:	803-438-4391

Provider Business Practice Location Address
First Line	:	40 PINNACLE PKWY
Second Line	:	SUITE 208
City	:	ELGIN
State	:	SC
Zip	:	29045-8390
Country	:	US
Telephone Number	:	803-424-5165
Fax Number	:	803-424-5174

Authorized Official
Title or Position	:	CFO
Name	:	ELIZABETH ESTEP
Credential	:
Telephone Number	:	615-764-3000

Provider Enumeration Date	:	07/15/2015
Last Update Date	:	07/15/2015

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Directions to “KERSHAW CLINICS LLC ” Practice Location

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