Healthcare Provider Details

I. General information

NPI: 1962119487
Provider Name (Legal Business Name): LEADS WAY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/03/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7766 W MAIN STREET
RIDGELAND SC
29936
US

IV. Provider business mailing address

186 STATE ROAD S-27-272
RIDGELAND SC
29936
US

V. Phone/Fax

Practice location:
  • Phone: 843-441-9415
  • Fax: 843-305-6107
Mailing address:
  • Phone: 843-476-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ANTREANA SINGLETON-GRANT
Title or Position: OWNER
Credential:
Phone: 843-476-3260