Provider Demographics
NPI:1366625808
Name:HARLEYVILLE FAMILY MEDICINE
Entity type:Organization
Organization Name:HARLEYVILLE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-496-7174
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29059
Mailing Address - Country:US
Mailing Address - Phone:803-496-7174
Mailing Address - Fax:803-496-7928
Practice Address - Street 1:146 JUDGE ST
Practice Address - Street 2:
Practice Address - City:HARLEYVILLE
Practice Address - State:SC
Practice Address - Zip Code:29448
Practice Address - Country:US
Practice Address - Phone:843-462-7355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY DIAGNOSTIC ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC142Medicaid
SCRHC142Medicaid