Low Country Health Care System | |
333 Revolutionary Trail Farifax SC 29827 | |
(803) 632-2533 | |
(803) 632-1537 |
Full Name | Low Country Health Care System |
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Speciality | Clinic/Center |
Location | 333 Revolutionary Trail, Farifax, South Carolina |
Authorized Official Name and Position | Megan Anderson (PHARMACIST) |
Authorized Official Contact | 8036322533 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Low Country Health Care System Po Box 990 Fairfax SC 29827 Ph: (803) 632-2533 | Low Country Health Care System 333 Revolutionary Trail Farifax SC 29827 Ph: (803) 632-2533 |
NPI Number | 1053475566 |
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Provider Enumeration Date | 12/20/2006 |
Last Update Date | 11/15/2023 |
Medicare PECOS PAC ID | 4284530940 |
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Medicare Enrollment ID | O20031211000944 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053475566 | NPI | - | NPPES |
751105 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | William M Yates |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1740361906 PECOS PAC ID: 6002709755 Enrollment ID: I20040205000792 |
Provider Name | Teresa A Williams |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1417977190 PECOS PAC ID: 0547234825 Enrollment ID: I20040823000915 |
Provider Name | Rossie Reid |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1205840733 PECOS PAC ID: 8628009719 Enrollment ID: I20050829000621 |
Provider Name | Richard Elmer Boyles |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1003820531 PECOS PAC ID: 7618900523 Enrollment ID: I20050912001155 |
Provider Name | Bryan Tolliver |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1972684199 PECOS PAC ID: 8022183367 Enrollment ID: I20080820000599 |
Provider Name | Gloria J Reed |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1962463521 PECOS PAC ID: 5496899874 Enrollment ID: I20100223000658 |
Provider Name | Lucille Sanders |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538170121 PECOS PAC ID: 4981734639 Enrollment ID: I20100608000046 |
Provider Name | Ronald D Padgett |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1942206362 PECOS PAC ID: 9638221781 Enrollment ID: I20100909000594 |
Provider Name | Janet Marie Mckissick |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1407878366 PECOS PAC ID: 5496938508 Enrollment ID: I20110328000610 |
Provider Name | John V Custer |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1578679452 PECOS PAC ID: 3476727140 Enrollment ID: I20111114000872 |
Provider Name | Courtney Sandifer Drawdy |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1801166277 PECOS PAC ID: 7618136995 Enrollment ID: I20120306000291 |
Provider Name | Abraham H Moskow |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1730221292 PECOS PAC ID: 7810179009 Enrollment ID: I20121128000134 |
Provider Name | Meredith C Hipp |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679826820 PECOS PAC ID: 3375796865 Enrollment ID: I20130111000416 |
Provider Name | James Robert Mynatt |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1588815021 PECOS PAC ID: 2961640123 Enrollment ID: I20130529000534 |
Provider Name | Baxter F Mclendon |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1033160254 PECOS PAC ID: 8022264274 Enrollment ID: I20131109000398 |
Provider Name | Saranne S Oneal |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336300748 PECOS PAC ID: 8628208691 Enrollment ID: I20140313001543 |
Provider Name | Bryan Allan Burnett |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1376685453 PECOS PAC ID: 5496937682 Enrollment ID: I20140710000638 |
Provider Name | Marsha Wren Carroll |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1093143836 PECOS PAC ID: 1951527233 Enrollment ID: I20140722001853 |
Provider Name | Vishal Abiraj |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1356652283 PECOS PAC ID: 8820239783 Enrollment ID: I20140814000873 |
Provider Name | Mari S Bridges |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1740543164 PECOS PAC ID: 3375780927 Enrollment ID: I20160614000651 |
Provider Name | John Young |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1306912530 PECOS PAC ID: 1355442088 Enrollment ID: I20160728001851 |
Provider Name | Christopher S Carroll |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1205389335 PECOS PAC ID: 8426346412 Enrollment ID: I20161006001040 |
Provider Name | Wanda W Tutt |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1851656243 PECOS PAC ID: 4789972233 Enrollment ID: I20161017000304 |
Provider Name | Kimberly Dawn Spires |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1194278879 PECOS PAC ID: 0547558918 Enrollment ID: I20161018001733 |
Provider Name | Edward Chaum |
---|---|
Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1023075868 PECOS PAC ID: 6406898493 Enrollment ID: I20161212000784 |
Provider Name | Jennifer Denise Rahn |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1689094666 PECOS PAC ID: 8820319619 Enrollment ID: I20170905002673 |
Provider Name | Vernon C Whitley |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1295818987 PECOS PAC ID: 8628051281 Enrollment ID: I20180806000878 |
Provider Name | Heather R Nolan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1902307598 PECOS PAC ID: 2860728839 Enrollment ID: I20190729002915 |
Provider Name | Anthony Mcpherson |
---|---|
Provider Type | Practitioner - Anesthesiology |
Provider Identifiers | NPI Number: 1477537660 PECOS PAC ID: 1052361722 Enrollment ID: I20190731004228 |
Provider Name | Kristen M Caulder |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1780220921 PECOS PAC ID: 5496181372 Enrollment ID: I20200213000302 |
Provider Name | Chinise Kayanna Clinton |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1023635935 PECOS PAC ID: 2860811064 Enrollment ID: I20201007000381 |
Provider Name | Lauren Ashley Ray-villalobos |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942834528 PECOS PAC ID: 5991115909 Enrollment ID: I20201103001386 |
Provider Name | Amy Ellis Kinard |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1720603202 PECOS PAC ID: 7315357332 Enrollment ID: I20201103001537 |
Provider Name | Alexis K Strang |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1386313062 PECOS PAC ID: 0244622298 Enrollment ID: I20220125000388 |
Provider Name | Erica O'quinn |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033860671 PECOS PAC ID: 7012302433 Enrollment ID: I20220322002836 |
Provider Name | Craig M Martin |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1063570646 PECOS PAC ID: 4880879758 Enrollment ID: I20220713002000 |
Provider Name | Ashley Roxanne Peterson |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1346700796 PECOS PAC ID: 9234511395 Enrollment ID: I20220805001379 |
Provider Name | Elizabeth Sandifer |
---|---|
Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
Provider Identifiers | NPI Number: 1730550963 PECOS PAC ID: 9133420623 Enrollment ID: I20221116000457 |
Provider Name | Lisa Davis |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1710608377 PECOS PAC ID: 1557739620 Enrollment ID: I20221121001734 |
Provider Name | Vicki Lynn Landis |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1194067066 PECOS PAC ID: 1557597515 Enrollment ID: I20230629001194 |
Provider Name | Walter Schmalstieg |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1740209683 PECOS PAC ID: 7618016262 Enrollment ID: I20230727000991 |
Provider Name | Vanessa Simmons |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1396149340 PECOS PAC ID: 7911359427 Enrollment ID: I20240120000405 |