1326171752 NPI number — LOWCOUNTRY HEALTHCARE, PA

Table of content: (NPI 1326171752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326171752 NPI number — LOWCOUNTRY HEALTHCARE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOWCOUNTRY HEALTHCARE, PA
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:
Provider Other Organization Name Type Code:
6
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:
1326171752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1230 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT PLEASANT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29464-3251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-388-0106
Provider Business Mailing Address Fax Number:
843-388-0107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1230 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29464-3251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-388-0106
Provider Business Practice Location Address Fax Number:
843-388-0107
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORGAN
Authorized Official First Name:
REX
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
843-388-0106

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  23358 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 27026 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: DD8758 . This is a "MEIDCARE RAILROAD GRP ID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP4254 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326171752 . This is a "NPI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: P00257343 . This is a "MEDICARE RAILROAD PROV ID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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