Healthcare Provider Details

I. General information

NPI: 1265426167
Provider Name (Legal Business Name): MACKEY FAMILY PRACTICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W MEETING ST SUITE 200
LANCASTER SC
29720-2204
US

IV. Provider business mailing address

1025 W MEETING ST SUITE 200
LANCASTER SC
29720-2204
US

V. Phone/Fax

Practice location:
  • Phone: 803-285-7414
  • Fax: 803-283-4329
Mailing address:
  • Phone: 803-285-7414
  • Fax: 803-283-4329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2674
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20303
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH D SHEALY
Title or Position: OWNER
Credential: M.D.
Phone: 803-285-7414