MEDICARE: LOWCOUNTRY MEDICAL ASSOCIATES

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		SC

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	:	1730139726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOWCOUNTRY MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	1064 GARDNER RD
Second Line	:	SUITE 105
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5768
Country	:	US
Telephone Number	:	843-226-0046
Fax Number	:

Provider Business Practice Location Address
First Line	:	1064 GARDNER RD
Second Line	:	SUITE 105
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5768
Country	:	US
Telephone Number	:	843-226-0046
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	LINDA C SHOEMAKER
Credential	:
Telephone Number	:	843-937-8101

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	10/17/2007

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