1518338698 NPI number — CAROLINA HEALTH CENTERS, INC.

Table of content: (NPI 1518338698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518338698 NPI number — CAROLINA HEALTH CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA HEALTH CENTERS, 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:
VILLAGE FAMILY PRACTICE
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:
1518338698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
313 MAIN ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29646-2757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-388-0301
Provider Business Mailing Address Fax Number:
864-388-0648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 EPTING AVE # B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29646-4040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-941-8121
Provider Business Practice Location Address Fax Number:
864-330-8237
Provider Enumeration Date:
10/14/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GILMER
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
864-941-8121

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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