Basic Information
| Provider Information | |||||||||
| NPI: | 1215235064 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LORIS COMMUNITY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SEACOAST PULMONOLOGY AND CRITICAL CARE ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3418 CASEY ST | ||||||||
| Address2: | |||||||||
| City: | LORIS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295692904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437167911 | ||||||||
| FaxNumber: | 8437167918 | ||||||||
| Practice Location | |||||||||
| Address1: | 3418 CASEY ST | ||||||||
| Address2: | |||||||||
| City: | LORIS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295692904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437167911 | ||||||||
| FaxNumber: | 8437167918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2011 | ||||||||
| LastUpdateDate: | 03/03/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | CAROLYN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | LORIS PHYSICIAN CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 8437167911 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LORIS COMMUNITY HOSPITAL DISTRICT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.