| Organization Name: | EMMAUS MED/SURG CLINIC |
| NPI Number: | 1871827790 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BERT B OUBRE (OWNER) |
| Mailing Address: | 602 E Main St Suite C Lexington |
| State: | SC US |
| Postal Code: | 290723729 |
| Phone Number: | 8033590164 |
| Fax Number: | 8033590255 |
| NPI Enumeration Date: | 09/24/2009 |
| NPI Last Update Date: | 09/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 30244 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |