Organization
LIVE OAK MEDICAL CENTER, PA
Active
Parent organization
LIVE OAK MEDICAL CENTER, PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIVE OAK MEDICAL CENTER, PA
Authorized official
ALBERT DURANT MIMS M.D. (DIRECTOR)
(843) 687-0435
Entity
Organization
Contact information
Practice address
148 SAULS ST., LAKE CITY, SC 29560
(843) 687-0435
Mailing address
148 SAULS ST., LAKE CITY, SC 29560
(843) 687-0435
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
05/20/2009
Last updated
05/17/2010
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