Provider Demographics
NPI:1114246584
Name:EAST MAIN MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:EAST MAIN MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:843-374-7020
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-0640
Mailing Address - Country:US
Mailing Address - Phone:843-374-7020
Mailing Address - Fax:843-374-7021
Practice Address - Street 1:238 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2114
Practice Address - Country:US
Practice Address - Phone:843-374-7020
Practice Address - Fax:843-374-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC423809Medicare Oscar/Certification