=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396807707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOWCOUNTRY MEDICAL ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2006
-----------------------------------------------------
Last Update Date | 10/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 BISHOP GADSDEN WAY
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29412-3506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-406-2362
-----------------------------------------------------
Fax | 843-406-2364
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2270 ASHLEY CROSSING DR STE 170
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29414-5732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-763-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | LINDA C SHOEMAKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 843-937-8101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------