Provider Demographics
NPI:1023029188
Name:PARTNERS IN HEALTH - RURAL HEALTH
Entity Type:Organization
Organization Name:PARTNERS IN HEALTH - RURAL HEALTH
Other - Org Name:LAURENS FAMILY PRACTICE AT GRAY COURT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-455-7978
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:864-797-6198
Practice Address - Street 1:9100 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:GRAY COURT
Practice Address - State:SC
Practice Address - Zip Code:29645-4152
Practice Address - Country:US
Practice Address - Phone:864-876-4888
Practice Address - Fax:864-876-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC085Medicaid
SC428920Medicare Oscar/Certification
SCRHC085Medicaid