Healthcare Provider Details

I. General information

NPI: 1568791895
Provider Name (Legal Business Name): LAURENS COUNTY HEALTH CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22725 HWY 76
CLINTON SC
29325-7527
US

IV. Provider business mailing address

22725 HWY 76
CLINTON SC
29325-7527
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-9141
  • Fax: 864-833-9357
Mailing address:
  • Phone: 864-833-9141
  • Fax: 864-833-9357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name: WILL GRANT
Title or Position: VP OF FISCAL AND SUPPORT SERVICES
Credential:
Phone: 864-833-3976