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22 Gardner Rd Blackville SC 29817-3126 | |
(803) 284-2041 | |
(803) 284-5516 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 22 Gardner Rd, Blackville, South Carolina |
Authorized Official Name and Position | Terri H Hicks (FINANCE DIRECTOR) |
Authorized Official Contact | 8035414173 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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22 Gardner Rd Po Box 247 Blackville SC 29817-3126 Ph: (803) 284-2041 | 22 Gardner Rd Blackville SC 29817-3126 Ph: (803) 284-2041 |
NPI Number | 1518196260 |
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Provider Enumeration Date | 07/02/2009 |
Last Update Date | 07/02/2009 |
Identifier | Type | State | Issuer |
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1518196260 | NPI | - | NPPES |
GPO0847 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Low Country Health Care System Mobile Health Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 130 Baker St N, Blackville, SC 29817 Phone: 803-284-1045 | |