Healthcare Provider Details

I. General information

NPI: 1295073559
Provider Name (Legal Business Name): FLORENCE SCHOOL DISTRICT FIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 EAST MARION ST.
JOHNSONVILLE SC
29555
US

IV. Provider business mailing address

156 E. MARION ST.
JOHNSONVILLE SC
29555-0098
US

V. Phone/Fax

Practice location:
  • Phone: 843-386-2066
  • Fax: 843-386-3786
Mailing address:
  • Phone: 843-386-2066
  • Fax: 843-386-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License NumberP26633
License Number StateSC

VIII. Authorized Official

Name: RANDY SMILEY
Title or Position: DISTRICT SUPERINTENDENT
Credential:
Phone: 843-386-2358