Organization Name: | MACKEY FAMILY PRACTICE, PA |
NPI Number: | 1700160157 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KEITH D SHEALY (PRESIDENT) |
Mailing Address: | 8351 Charlotte Hwy Suite 200 Indian Land |
State: | SC US |
Postal Code: | 297076552 |
Phone Number: | 8033965368 |
Fax Number: | 8033965350 |
NPI Enumeration Date: | 10/04/2011 |
NPI Last Update Date: | 07/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |