MEDICARE: FAMILY MEDICINE CENTERS OF SOUTH CAROLINA, P.A.

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	261QP2300X	Primary Care Clinic/Center

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	:	1265525455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICINE CENTERS OF SOUTH CAROLINA, P.A.

Provider Business Mailing Address
First Line	:	1910 GREGG ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2618
Country	:	US
Telephone Number	:	803-779-1420
Fax Number	:	803-931-0676

Provider Business Practice Location Address
First Line	:	813 LEESBURG RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-2127
Country	:	US
Telephone Number	:	803-779-1420
Fax Number	:	803-931-0676

Authorized Official
Title or Position	:	CEO/MEDICAL DIRECTOR
Name	:	DR. STEPHEN F SERBIN
Credential	:	M.D.
Telephone Number	:	803-779-1420

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	11/08/2007

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