Healthcare Provider Details

I. General information

NPI: 1700378767
Provider Name (Legal Business Name): DENMARK-OLAR MIDDLE SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 GREEN ST
DENMARK SC
29042
US

IV. Provider business mailing address

3310 MAGNOLIA ST
ORANGEBURG SC
29115-1466
US

V. Phone/Fax

Practice location:
  • Phone: 803-793-3383
  • Fax:
Mailing address:
  • Phone: 803-531-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STAN WARDLAW
Title or Position: CEO
Credential:
Phone: 803-531-6900