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General NPI Number Information
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NPI Number | 1629021076
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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 | 05/18/2006
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 4303 LIVE OAK DR
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City | LITTLE RIVER
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State | SC
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Zip | 29566-9138
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Country | US
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Telephone | 843-663-8000
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Fax | 843-280-2455
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Provider Business Mailing Address
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Address Line | PO BOX 547
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City | LITTLE RIVER
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State | SC
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Zip | 29566-0547
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Country | US
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Telephone | 843-663-8000
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Fax | 843-663-1017
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Authorized Official
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Title or Position | CEO
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Name | PAMELA R DAVIS
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Credential |
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Telephone | 843-663-8001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number |
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License Number State | SC
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Taxonomy #4
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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 | SC
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Taxonomy #5
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State | SC
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | SC
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Taxonomy #7
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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