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NPI Code Detail

MEDICARE: DR. KEITH D SHEALY M.D.

MEDICARE: DR. KEITH D SHEALY M.D.
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
1207Q00000XFamily Medicine Physician10924SC

Other Identifiers

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

General Provider Information

NPI Number : 1578557153
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH D SHEALY M.D.
Provider Business Mailing Address
First Line : 1025 W MEETING ST STE 200
Second Line :
City : LANCASTER
State : SC
Zip : 29720-2246
Country : US
Telephone Number : 803-285-7414
Fax Number : 803-283-4329
Provider Business Practice Location Address
First Line : 1025 W MEETING ST STE 200
Second Line :
City : LANCASTER
State : SC
Zip : 29720-2246
Country : US
Telephone Number : 803-285-7414
Fax Number : 803-283-4329
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2005
Last Update Date : 05/11/2026

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Directions to “ DR. KEITH D SHEALY M.D.” Practice Location

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