Basic Information
| Provider Information | |||||||||
| NPI: | 1437353794 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY HEALTH CENTERS, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SAINT GEORGE MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 401 RIDGE ST | ||||||||
| Address2: | |||||||||
| City: | SAINT GEORGE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294772451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035316900 | ||||||||
| FaxNumber: | 8035316907 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 RIDGE ST | ||||||||
| Address2: | |||||||||
| City: | SAINT GEORGE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294772451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035316900 | ||||||||
| FaxNumber: | 8035316907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 03/01/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STEPHENS | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CLINICAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 8035316900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.