Organization
LORIS MEDICAL CENTER, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WANDA GRAHAM (PRACTICE ADMINISTRATOR)
(843) 756-5300
Entity
Organization
Contact information
Practice address
3439 CASEY ST, LORIS, SC 29569-2903
(843) 756-1582
(843) 756-2042
Mailing address
3439 CASEY ST, LORIS, SC 29569-2903
(843) 756-5300
(843) 756-6059
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0291J
NORTH CAROLINA BCBS
NC
01
—
4771
PALMETTO MEDICARE
SC
05
—
5950200
—
NC
01
—
CA6664
RAILROAD MEDICARE
SC
05
—
GP1053
—
SC
Enumeration date
06/25/2006
Last updated
09/10/2009
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