Provider Demographics
NPI:1083815799
Name:LOWER FLORENCE COUNTY HOSPITAL
Entity Type:Organization
Organization Name:LOWER FLORENCE COUNTY HOSPITAL
Other - Org Name:PEE DEE FAMILY PRACTICE JOHNSONVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PFS
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-374-6431
Mailing Address - Street 1:258 N RON MCNAIR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2462
Mailing Address - Country:US
Mailing Address - Phone:843-374-2036
Mailing Address - Fax:843-374-5315
Practice Address - Street 1:625 S GEORGETOWN HWY
Practice Address - Street 2:
Practice Address - City:JOHNSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29555
Practice Address - Country:US
Practice Address - Phone:843-386-2350
Practice Address - Fax:843-386-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCGP2834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2834Medicaid