Healthcare Provider Details

I. General information

NPI: 1164702114
Provider Name (Legal Business Name): COMMUNITY MEDICINE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S HERLONG AVE
ROCK HILL SC
29732-2730
US

IV. Provider business mailing address

PO BOX 28
ROCK HILL SC
29731-6028
US

V. Phone/Fax

Practice location:
  • Phone: 803-325-7744
  • Fax:
Mailing address:
  • Phone: 803-325-8742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ERNEST G. BROWN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-325-7744