Healthcare Provider Details

I. General information

NPI: 1568544591
Provider Name (Legal Business Name): COMMUNITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10278 OLD #6 HIGHWAY
VANCE SC
29163
US

IV. Provider business mailing address

10278 OLD #6 HIGHWAY
VANCE SC
29163
US

V. Phone/Fax

Practice location:
  • Phone: 803-531-6900
  • Fax: 803-531-6907
Mailing address:
  • Phone: 803-531-6900
  • Fax: 803-531-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number50002540
License Number StateSC

VIII. Authorized Official

Name: DR. ARTHUR KOBINA KENNEDY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 803-531-6900