Organization
LITTLE RIVER MEDICAL CENTER INC
Active
Parent organization
LITTLE RIVER MEDICAL CENTER, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
LITTLE RIVER MEDICAL CENTER, INC.
Authorized official
MRS. AVANGELA KAY CRISWELL (BUSINESS OFFICE DIRECTOR)
(843) 663-8017
Entity
Organization
Contact information
Practice address
4303 LIVE OAK DR, LITTLE RIVER, SC 29566-9138
(843) 663-8000
(843) 663-8154
Mailing address
PO BOX 547, LITTLE RIVER, SC 29566-0547
(843) 663-8017
(843) 663-1017
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4406
SC
261QF0400X
Federally Qualified Health Center (FQHC)
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—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9656
—
SC
Enumeration date
12/12/2006
Last updated
11/02/2012
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