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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

General Provider Information

NPI Number : 1811930076
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARESOUTH CAROLINA, INC.
Provider Business Mailing Address
First Line : PO BOX 1090
Second Line :
City : HARTSVILLE
State : SC
Zip : 29551-1090
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3080 HIGHWAY 15-401 E
Second Line :
City : MC COLL
State : SC
Zip : 29570-6128
Country : US
Telephone Number : 843-523-5751
Fax Number :
Authorized Official
Title or Position : CEO
Name : ANN LEWIS
Credential :
Telephone Number : 843-857-0111
Provider Enumeration Date : 06/14/2006
Last Update Date : 06/17/2019

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Directions to “CARESOUTH CAROLINA, INC. ” Practice Location

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