Healthcare Provider Details

I. General information

NPI: 1700830254
Provider Name (Legal Business Name): LANCASTER WOMEN'S CENTER,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 W MEETING ST
LANCASTER SC
29720-2222
US

IV. Provider business mailing address

PO BOX 1897
LANCASTER SC
29721-1897
US

V. Phone/Fax

Practice location:
  • Phone: 803-286-6922
  • Fax: 803-286-4878
Mailing address:
  • Phone: 803-286-6922
  • Fax: 803-286-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number27304
License Number StateSC

VIII. Authorized Official

Name: DR. DOUGLAS L. TIEDT
Title or Position: PRESIDENT
Credential: MD
Phone: 803-286-6922