Provider Demographics
NPI:1134301625
Name:LAKE CITY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:LAKE CITY COMMUNITY HOSPITAL
Other - Org Name:PEE DEE HEALTH CARE, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEATHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-395-8404
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:843-395-8404
Mailing Address - Fax:843-395-8435
Practice Address - Street 1:201 CASHUA ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-3301
Practice Address - Country:US
Practice Address - Phone:843-393-7452
Practice Address - Fax:843-393-6210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE CITY COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-27
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC423433Medicare PIN
SC423433Medicare Oscar/Certification