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NPI Code Detail

MEDICARE: CARESOUTH CAROLINA, INC.

MEDICARE: CARESOUTH CAROLINA, INC.
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
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720082571
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARESOUTH CAROLINA, INC.
Provider Business Mailing Address
First Line : 201 S 5TH ST
Second Line :
City : HARTSVILLE
State : SC
Zip : 29550-4211
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1268 S 4TH ST
Second Line :
City : HARTSVILLE
State : SC
Zip : 29550-0703
Country : US
Telephone Number : 843-332-3422
Fax Number :
Authorized Official
Title or Position : CEO
Name : ANN LEWIS
Credential :
Telephone Number : 843-857-0111
Provider Enumeration Date : 06/09/2005
Last Update Date : 09/04/2007

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Directions to “CARESOUTH CAROLINA, INC. ” Practice Location

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