MEDICARE: LORIS COMMUNITY HOSPITAL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194806604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORIS COMMUNITY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	3655 MITCHELL ST
Second Line	:	BOX 690001
City	:	LORIS
State	:	SC
Zip	:	29569
Country	:	US
Telephone Number	:	843-392-9222
Fax Number	:	843-392-1445

Provider Business Practice Location Address
First Line	:	5260 HWY 9
Second Line	:
City	:	GREEN SEA
State	:	SC
Zip	:	29545
Country	:	US
Telephone Number	:	843-392-9222
Fax Number	:	843-392-1445

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT/CFO
Name	:	MR. FRED O TODD
Credential	:
Telephone Number	:	843-716-7520

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	01/14/2008

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