MEDICARE: LOMAX AND JORDAN ENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164620779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOMAX AND JORDAN ENT

Provider Business Mailing Address
First Line	:	208 E 2ND NORTH ST
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6858
Country	:	US
Telephone Number	:	843-873-6873
Fax Number	:	843-871-7111

Provider Business Practice Location Address
First Line	:	208 E 2ND NORTH ST
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6858
Country	:	US
Telephone Number	:	843-873-6873
Fax Number	:	843-871-7111

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM R LOMAX
Credential	:	MD
Telephone Number	:	843-873-6873

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	04/20/2008

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Directions to “LOMAX AND JORDAN ENT ” Practice Location

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