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Organization

LIVE OAK MEDICAL CENTER, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ALBERT DURANT MIMS M.D. (DIRECTOR)
(843) 374-3621
Entity
Organization

Contact information

Practice address
148 SAULS ST., LAKE CITY, SC 29560
(843) 687-0435
(843) 374-3624
Mailing address
148 SAULS ST., LAKE CITY, SC 29560
(843) 374-3621
(843) 374-3624

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9352
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GP5322
SC
Enumeration date
05/20/2009
Last updated
01/20/2010
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