Healthcare Provider Details

I. General information

NPI: 1215235064
Provider Name (Legal Business Name): LORIS COMMUNITY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3418 CASEY ST
LORIS SC
29569-2904
US

IV. Provider business mailing address

3418 CASEY ST
LORIS SC
29569-2904
US

V. Phone/Fax

Practice location:
  • Phone: 843-716-7911
  • Fax: 843-716-7918
Mailing address:
  • Phone: 843-716-7911
  • Fax: 843-716-7918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN WARD
Title or Position: LORIS PHYSICIAN CREDENTIALING
Credential:
Phone: 843-716-7911