MEDICARE: LOW COUNTRY HEALTH CARE SYSTEM, INC

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	261QF0400X	Federally Qualified Health Center (FQHC)

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	:	1922468826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOW COUNTRY HEALTH CARE SYSTEM, INC

Provider Business Mailing Address
First Line	:	86 WREN ST
Second Line	:
City	:	BARNWELL
State	:	SC
Zip	:	29812-1529
Country	:	US
Telephone Number	:	803-259-5762
Fax Number	:	803-259-3250

Provider Business Practice Location Address
First Line	:	13649 CHURCH ST
Second Line	:
City	:	WILLISTON
State	:	SC
Zip	:	29853-5835
Country	:	US
Telephone Number	:	803-266-0060
Fax Number	:	803-266-0065

Authorized Official
Title or Position	:	CEO
Name	:	ASHLEY BARNES
Credential	:
Telephone Number	:	803-632-2533

Provider Enumeration Date	:	03/04/2016
Last Update Date	:	01/11/2024

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