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14405 Bells Hwy Lodge SC 29082-9331 | |
(843) 768-9518 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 14405 Bells Hwy, Lodge, South Carolina |
Authorized Official Name and Position | Ronald A Ravenell (CEO) |
Authorized Official Contact | 8437224112 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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51 Nassau St Charleston SC 29403-5513 Ph: (843) 722-4112 | 14405 Bells Hwy Lodge SC 29082-9331 Ph: (843) 768-9518 |
NPI Number | 1760770994 |
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Provider Enumeration Date | 07/21/2011 |
Last Update Date | 07/21/2011 |
Identifier | Type | State | Issuer |
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1760770994 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |