Provider Demographics
NPI:1437515814
Name:HARTSVILLE SC PRIMARY CARE LLC
Entity Type:Organization
Organization Name:HARTSVILLE SC PRIMARY CARE LLC
Other - Org Name:HARTSVILLE PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:843-332-5111
Mailing Address - Street 1:528 E CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4312
Mailing Address - Country:US
Mailing Address - Phone:843-332-5111
Mailing Address - Fax:843-383-8991
Practice Address - Street 1:528 E CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4312
Practice Address - Country:US
Practice Address - Phone:843-332-5111
Practice Address - Fax:843-383-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1278363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty