MEDICARE: LANCASTER CLINIC CORP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588825616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANCASTER CLINIC CORP

Provider Business Mailing Address
First Line	:	206 SOUTH MATSON ST
Second Line	:
City	:	KERSHAW
State	:	SC
Zip	:	29067-1506
Country	:	US
Telephone Number	:	803-475-1156
Fax Number	:	803-475-1128

Provider Business Practice Location Address
First Line	:	206 SOUTH MATSON ST
Second Line	:
City	:	KERSHAW
State	:	SC
Zip	:	29067-1506
Country	:	US
Telephone Number	:	803-475-1156
Fax Number	:	803-475-1128

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DEBBIE BREWER
Credential	:
Telephone Number	:	877-892-9813

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	07/21/2010

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Directions to “LANCASTER CLINIC CORP ” Practice Location

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