Healthcare Provider Details

I. General information

NPI: 1154594786
Provider Name (Legal Business Name): LAKELANDS ORTHOPAEDIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 COMMERCIAL DRIVE
ABBEVILLE SC
29620-5593
US

IV. Provider business mailing address

PO BOX 3243
GREENWOOD SC
29646-3243
US

V. Phone/Fax

Practice location:
  • Phone: 864-366-8332
  • Fax: 864-366-0635
Mailing address:
  • Phone: 864-229-2663
  • Fax: 864-223-5694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN POORE
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 864-323-0527