Healthcare Provider Details

I. General information

NPI: 1538127352
Provider Name (Legal Business Name): CAROLINA HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 AIKEN RD.
RIDGE SPRING SC
29129
US

IV. Provider business mailing address

PO BOX 128
RIDGE SPRING SC
29129
US

V. Phone/Fax

Practice location:
  • Phone: 803-685-3100
  • Fax: 803-685-5831
Mailing address:
  • Phone: 803-685-3100
  • Fax: 803-685-5831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA Y GILMER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 864-941-8121