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
342 W MAIN ST, KINGSTREE, SC 29556-3235
(843) 687-0435
Mailing address
342 W MAIN ST, KINGSTREE, SC 29556-3235
(843) 687-0435
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
9352
SC
Other
Enumeration date
05/20/2009
Last updated
06/04/2009
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