MEDICARE: CAROLINA BIRTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083912984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA BIRTH CENTER

Provider Business Mailing Address
First Line	:	915 SOUTH ST STE J
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-3210
Country	:	US
Telephone Number	:	864-329-0010
Fax Number	:	864-228-2221

Provider Business Practice Location Address
First Line	:	915 SOUTH ST STE J
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-3210
Country	:	US
Telephone Number	:	864-329-0010
Fax Number	:	864-228-2221

Authorized Official
Title or Position	:	OWNER
Name	:	CYNTHIA GLENN
Credential	:
Telephone Number	:	864-329-0010

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	03/02/2011

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Directions to “CAROLINA BIRTH CENTER ” Practice Location

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