Provider Demographics
NPI:1437179983
Name:CAROLINA CONTINENCE CENTER, LLC
Entity Type:Organization
Organization Name:CAROLINA CONTINENCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FLEMING
Authorized Official - Last Name:MATTOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-286-1520
Mailing Address - Street 1:369 HALTON ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607
Mailing Address - Country:US
Mailing Address - Phone:864-286-1520
Mailing Address - Fax:864-286-1462
Practice Address - Street 1:369 HALTON ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-286-1520
Practice Address - Fax:864-286-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18432207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8456Medicare PIN