1134252588 NPI number — CAROLINA RURAL PRACTICE MANAGEMENT, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134252588 NPI number — CAROLINA RURAL PRACTICE MANAGEMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA RURAL PRACTICE MANAGEMENT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WILLISTON MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134252588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 177
Provider Second Line Business Mailing Address:
2677 MAIN STREET
Provider Business Mailing Address City Name:
WILLISTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29853-0177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-266-5740
Provider Business Mailing Address Fax Number:
803-266-5607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2677 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLISTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29853-0177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-266-5740
Provider Business Practice Location Address Fax Number:
803-266-5607
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALSBROOKS
Authorized Official First Name:
CHARLIE
Authorized Official Middle Name:
CLIFTON
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
803-641-6277

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  08504 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RHC028 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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