Provider Demographics
NPI:1306003462
Name:MEDICINE CENTER
Entity Type:Organization
Organization Name:MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,RPH
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:VEANNA
Authorized Official - Last Name:OSEAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-355-3136
Mailing Address - Street 1:503 THURGOOD MARSHALL HWY
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-4107
Mailing Address - Country:US
Mailing Address - Phone:843-355-3136
Mailing Address - Fax:843-355-3137
Practice Address - Street 1:503 THURGOOD MARSHALL HWY
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4107
Practice Address - Country:US
Practice Address - Phone:843-355-3136
Practice Address - Fax:843-355-3137
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARY VEANNA OSEANDBA MEDICINE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500025803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC725802Medicaid