Provider Demographics
NPI:1285635219
Name:CALABASH MEDICAL CENTER,PA
Entity Type:Organization
Organization Name:CALABASH MEDICAL CENTER,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS BILLING/COLLECTIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:GORE
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-756-5300
Mailing Address - Street 1:3439 CASEY ST
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-2903
Mailing Address - Country:US
Mailing Address - Phone:800-579-7971
Mailing Address - Fax:910-579-2407
Practice Address - Street 1:10081 BEACH DR SW
Practice Address - Street 2:
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467-2713
Practice Address - Country:US
Practice Address - Phone:800-579-7971
Practice Address - Fax:910-579-2407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRCH006OtherSC MEDICAID
NC343935AOtherNC MEDICAID CAROLINA ACCESS
NC5950176Medicaid
NCCA9979OtherRAILROAD MEDICARE
SCNPA648Medicaid
NC343935AOtherNC MEDICAID CAROLINA ACCESS