Healthcare Provider Details

I. General information

NPI: 1710958210
Provider Name (Legal Business Name): FOOTHILLS FAMILY MEDICINE OF WESTMINSTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W MAIN ST
WESTMINSTER SC
29693-1668
US

IV. Provider business mailing address

111 W MAIN ST
WESTMINSTER SC
29693-1668
US

V. Phone/Fax

Practice location:
  • Phone: 864-647-1820
  • Fax: 864-647-0403
Mailing address:
  • Phone: 864-647-1820
  • Fax: 864-647-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number11770
License Number StateSC

VIII. Authorized Official

Name: SHANNON DICKSON
Title or Position: BILLING MANAGER
Credential:
Phone: 864-647-1820