Healthcare Provider Details

I. General information

NPI: 1609212232
Provider Name (Legal Business Name): SOUTH CAROLINA GROUP SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HOSPITAL DR
MOUNT PLEASANT SC
29464-3764
US

IV. Provider business mailing address

PO BOX 21330
BELFAST ME
04915-4110
US

V. Phone/Fax

Practice location:
  • Phone: 770-874-5439
  • Fax: 770-874-5483
Mailing address:
  • Phone: 770-874-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM H LARSEN
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 770-874-5400