Healthcare Provider Details

I. General information

NPI: 1457604142
Provider Name (Legal Business Name): LOWCOUNTRY HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 OLD MOUNT HOLLY ROAD
GOOSE CREEK SC
29445-2773
US

IV. Provider business mailing address

588 OLD MOUNT HOLLY ROAD
GOOSE CREEK SC
29445-2773
US

V. Phone/Fax

Practice location:
  • Phone: 843-376-5595
  • Fax: 843-797-7432
Mailing address:
  • Phone: 843-376-5595
  • Fax: 843-797-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2773
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JENS FRANZEN
Title or Position: OWNER
Credential: D.C
Phone: 843-376-5595