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General NPI Number Information
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NPI Number | 1962119487
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Entity Type | Organization
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Legal Business Name | LEADS WAY MEDICAL CENTER
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 7766 W MAIN STREET
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City | RIDGELAND
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State | SC
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Zip | 29936
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Country | US
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Telephone | 843-441-9415
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Fax | 843-305-6107
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Provider Business Mailing Address
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Address Line | 186 STATE ROAD S-27-272
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City | RIDGELAND
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State | SC
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Zip | 29936
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Country | US
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Telephone | 843-476-3260
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANTREANA SINGLETON-GRANT
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Credential |
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Telephone | 843-476-3260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM3000X
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Taxonomy Name | Medically Fragile Infants and Children Day Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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