MEDICARE: ST LUKE MISSIONARY HOSPICE OF SOUTH CAROLINA, LLC

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1225479207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LUKE MISSIONARY HOSPICE OF SOUTH CAROLINA, LLC

Provider Business Mailing Address
First Line	:	16 WILLIAM POPE DR
Second Line	:	SUITE 201
City	:	BLUFFTON
State	:	SC
Zip	:	29909-7502
Country	:	US
Telephone Number	:	843-473-3055
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 WILLIAM POPE DR
Second Line	:	SUITE 201
City	:	BLUFFTON
State	:	SC
Zip	:	29909-7502
Country	:	US
Telephone Number	:	843-473-3055
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. STEVEN FRISCH
Credential	:
Telephone Number	:	843-473-3055

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	06/23/2016

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