Provider Demographics
NPI:1508103797
Name:ANDERSON DISTRICT 4
Entity Type:Organization
Organization Name:ANDERSON DISTRICT 4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:S
Authorized Official - Last Name:COTHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:ADN
Authorized Official - Phone:864-403-2308
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:550 WILLIAMS ST
Mailing Address - City:LAFRANCE
Mailing Address - State:SC
Mailing Address - Zip Code:29656
Mailing Address - Country:US
Mailing Address - Phone:864-403-2308
Mailing Address - Fax:
Practice Address - Street 1:550 WILLIAMS STREET
Practice Address - Street 2:
Practice Address - City:LA FRANCE
Practice Address - State:SC
Practice Address - Zip Code:29656
Practice Address - Country:US
Practice Address - Phone:864-403-2308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC41578163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSD0404Medicaid