Organization
LITTLE RIVER MEDICAL CENTER, INC.
Active
Parent organization
LITTLE RIVER MEDICAL CENTER, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
LITTLE RIVER MEDICAL CENTER, INC.
Authorized official
MRS. AVANGELA KAY CRISWELL (BUSINESS OFFICE DIRECTOR)
(843) 663-1013
Entity
Organization
Contact information
Practice address
1075 MR. JOE WHITE AVE, UNIT 101, MYRTLE BEACH, SC 29577-5658
(843) 839-2049
(843) 839-1857
Mailing address
PO BOX 547, LITTLE RIVER, SC 29566-0547
(843) 663-1013
(843) 663-1017
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
SC
1041C0700X
Clinical Social Worker
—
SC
207Q00000X
Family Medicine Physician
—
SC
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FQC066
—
SC
Enumeration date
12/18/2006
Last updated
08/02/2024
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