Provider Demographics
NPI:1053475566
Name:LOW COUNTRY HEALTH CARE SYSTEM, INC
Entity Type:Organization
Organization Name:LOW COUNTRY HEALTH CARE SYSTEM, INC
Other - Org Name:LOW COUNTRY HEALTH CARE SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-632-2533
Mailing Address - Street 1:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:SC
Mailing Address - Zip Code:29827
Mailing Address - Country:US
Mailing Address - Phone:803-632-2533
Mailing Address - Fax:803-632-1537
Practice Address - Street 1:333 REVOLUTIONARY TRAIL
Practice Address - Street 2:
Practice Address - City:FARIFAX
Practice Address - State:SC
Practice Address - Zip Code:29827
Practice Address - Country:US
Practice Address - Phone:803-632-2533
Practice Address - Fax:803-632-1537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC751105Medicaid
SCBL6736182OtherDEA