Provider Demographics
NPI:1467781005
Name:LORIS COMMUNITY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:LORIS COMMUNITY HOSPITAL DISTRICT
Other - Org Name:DBA SOUTHERN MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LORIS PHYSICIAN CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-880-6406
Mailing Address - Street 1:3418 CASEY ST
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-2904
Mailing Address - Country:US
Mailing Address - Phone:843-756-7885
Mailing Address - Fax:843-756-7855
Practice Address - Street 1:3418 CASEY ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2904
Practice Address - Country:US
Practice Address - Phone:843-756-7885
Practice Address - Fax:843-756-7855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LORIS COMMUNITY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-10
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty