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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1760678841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANCASTER CLINIC CORP

Provider Business Mailing Address
First Line	:	4000 MERIDIAN BLVD
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6325
Country	:	US
Telephone Number	:	615-465-7000
Fax Number	:	615-465-3007

Provider Business Practice Location Address
First Line	:	206 S 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 OF PROVIDER ENROLLMENT
Name	:	DEBBIE BREWER
Credential	:
Telephone Number	:	615-465-7000

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	12/21/2007

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Directions to “LANCASTER CLINIC CORP ” Practice Location

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