Provider Demographics
NPI:1306042585
Name:CAROLINA MEDICAL CENTER OF WALTERBORO PA
Entity Type:Organization
Organization Name:CAROLINA MEDICAL CENTER OF WALTERBORO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-549-4335
Mailing Address - Street 1:461 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2766
Mailing Address - Country:US
Mailing Address - Phone:843-549-4335
Mailing Address - Fax:
Practice Address - Street 1:461 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2766
Practice Address - Country:US
Practice Address - Phone:843-549-4335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1275632309OtherDR. KUMAR'S NPI
SC19591OtherDR.B'S STATE LICENSE #
SC195915Medicaid
SC621156OtherDR.K'S FIRST CHOICE #
SCH016147061OtherDR.B'S RAIL ROAD MC#
SC452043939OtherDR.B'S BC#
SC452043939OtherDR.B'S SS#
SC487949774OtherDR.K'S SS#
SC164379Medicaid
SC110222814OtherDR.KUMAR'SRAIL ROAD MC #
SC16437OtherDR.K'S STATE LICENSE #
SC20018291OtherDR.B'S FIRST CHOICE #
SC164379Medicaid
SC452043939OtherDR.B'S BC#
SC164379Medicaid