MEDICARE: LISA M WRIGHT 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
1	207Q00000X	Family Medicine Physician	25363	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00352728	OTHER	SC	RR MEDICARE

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
2	576007863002	OTHER	SC	BLUE CHOICE OF SC
3	576007863002	OTHER	SC	BCBS OF SC

General Provider Information

NPI Number	:	1700825858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M WRIGHT M.D.

Provider Business Mailing Address
First Line	:	276 N RON MCNAIR BLVD
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-2462
Country	:	US
Telephone Number	:	843-394-5471
Fax Number	:	433-945-4598

Provider Business Practice Location Address
First Line	:	276 N RON MCNAIR BLVD
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-2462
Country	:	US
Telephone Number	:	843-394-5471
Fax Number	:	433-945-4598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	10/10/2023

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Directions to “ LISA M WRIGHT M.D.” Practice Location

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