Basic Information
| Provider Information | |||||||||
| NPI: | 1487942157 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LIVE OAK MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 148 SAULS ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295602631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433743621 | ||||||||
| FaxNumber: | 8433743624 | ||||||||
| Practice Location | |||||||||
| Address1: | 148 SAULS ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295602631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433743621 | ||||||||
| FaxNumber: | 8433743624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2011 | ||||||||
| LastUpdateDate: | 07/15/2011 | ||||||||
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| AuthorizedOfficialLastName: | AARD | ||||||||
| AuthorizedOfficialFirstName: | MYRA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8433743621 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.