Organization
LAKE CITY ORTHOPAEDIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY DUKE (DIRECTOR)
(843) 374-6431
Entity
Organization
Contact information
Practice address
330 MERCY ST, LAKE CITY, SC 29560-2332
(843) 374-5267
(843) 374-6243
Mailing address
PO BOX 1479, LAKE CITY, SC 29560-1479
(843) 374-5267
(843) 374-6243
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400667
—
SC
Enumeration date
10/28/2009
Last updated
10/28/2009
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