Provider Demographics
NPI:1538127352
Name:CAROLINA HEALTH CENTERS, INC.
Entity Type:Organization
Organization Name:CAROLINA HEALTH CENTERS, INC.
Other - Org Name:RIDGE SPRING FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GILMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-941-8121
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:RIDGE SPRING
Mailing Address - State:SC
Mailing Address - Zip Code:29129
Mailing Address - Country:US
Mailing Address - Phone:803-685-3100
Mailing Address - Fax:803-685-5831
Practice Address - Street 1:201 AIKEN RD.
Practice Address - Street 2:
Practice Address - City:RIDGE SPRING
Practice Address - State:SC
Practice Address - Zip Code:29129
Practice Address - Country:US
Practice Address - Phone:803-685-3100
Practice Address - Fax:803-685-5831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC020Medicaid
SCFQC020Medicaid
SC=========001OtherBLUE CROSS
SC5541Medicare ID - Type Unspecified