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General NPI Number Information
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NPI Number | 1619158938
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Entity Type | Organization
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Legal Business Name | LITTLE RIVER MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 5000 TULIP GROVE RD
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City | GREEN SEA
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State | SC
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Zip | 29545-4977
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Country | US
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Telephone | 843-392-1078
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Fax | 843-392-1090
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Provider Business Mailing Address
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Address Line | 287 HIGHWAY 90 E STE 5 STE#5
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City | LITTLE RIVER
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State | SC
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Zip | 29566-7214
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Country | US
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Telephone | 843-663-1017
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Fax | 843-663-1013
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Authorized Official
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Title or Position | BUSINESS OFFICE DIRECTOR
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Name | AVANGELA KAY CRISWELL
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Credential |
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Telephone | 843-663-1013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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