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General NPI Number Information
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NPI Number | 1265426167
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Entity Type | Organization
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Legal Business Name | MACKEY FAMILY PRACTICE, PA
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 1025 W MEETING ST SUITE 200
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City | LANCASTER
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State | SC
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Zip | 29720-2204
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Country | US
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Telephone | 803-285-7414
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Fax | 803-283-4329
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Provider Business Mailing Address
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Address Line | 1025 W MEETING ST SUITE 200
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City | LANCASTER
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State | SC
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Zip | 29720-2204
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Country | US
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Telephone | 803-285-7414
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Fax | 803-283-4329
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEITH D SHEALY
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Credential | M.D.
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Telephone | 803-285-7414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2674
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 20303
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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