Organization
CAROLINA RURAL PRACTICE MANAGEMENT, INC.
Active
Other names
Wagener Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLIE CLIFTON ALSBROOKS (ADMINISTRATOR)
(803) 641-6277
Entity
Organization
Contact information
Practice address
120 LOUIE STREET, WAGENER, SC 29164-0098
(803) 564-6497
(803) 564-6498
Mailing address
PO BOX 98, 120 LOUIE ST, WAGENER, SC 29164-0098
(803) 564-6497
(803) 564-6498
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
08504
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RHC025
—
SC
Enumeration date
03/14/2007
Last updated
07/12/2007
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