Organization
CARESOUTH CAROLINA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN M LEWIS (CEO)
(843) 857-0111
Entity
Organization
Contact information
Practice address
210 W MAIN ST, BENNETTSVILLE, SC 29512-3122
(843) 479-1200
(843) 479-1230
Mailing address
PO BOX 1090, HARTSVILLE, SC 29551-1090
(843) 857-0111
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FQC093
—
SC
Enumeration date
08/09/2011
Last updated
03/21/2012
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