Organization
MID-ISLAND PRIMARY AND URGENT CARE, LLC
Active
Parent organization
SOUTH CAROLINA HEALTH SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTH CAROLINA HEALTH SERVICES
Authorized official
WESLEY O. JAMES (REGIONAL CFO, TENET)
(404) 265-5009
Entity
Organization
Contact information
Practice address
58 SHELTER COVE LN, STE L, HILTON HEAD ISLAND, SC 29928-3571
(843) 681-2074
Mailing address
PO BOX 100208, ATLANTA, GA 30384-0208
(843) 681-2074
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8845
MEDICARE PTAN
SC
05
—
GP4951
—
SC
Enumeration date
05/15/2007
Last updated
06/08/2016
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