Basic Information
| Provider Information | |||||||||
| NPI: | 1316953649 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LOWER FLORENCE COUNTY HOSPTIAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | PALMETTO PRIMARY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 258 N RON MCNAIR BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295602462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433742036 | ||||||||
| FaxNumber: | 8433745315 | ||||||||
| Practice Location | |||||||||
| Address1: | 334 MERCY ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295602332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433749355 | ||||||||
| FaxNumber: | 8433747953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 11/05/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROBINSON | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINIC COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8433742036 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LOWER FLORENCE COUNTY HOSPITAL | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | RHC149 | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.