Provider Demographics
NPI:1639140445
Name:LORIS COMMUNITY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:LORIS COMMUNITY HOSPITAL DISTRICT
Other - Org Name:LORIS HEALTHCARE SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:O
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-716-7271
Mailing Address - Street 1:3655 MITCHELL ST, BOX 690001
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-9601
Mailing Address - Country:US
Mailing Address - Phone:843-716-7596
Mailing Address - Fax:843-716-7093
Practice Address - Street 1:3655 MITCHELL STREET
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-9601
Practice Address - Country:US
Practice Address - Phone:843-716-7596
Practice Address - Fax:843-716-7093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
SCHTL033282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6907689Medicaid
SC171505Medicaid
NC0006YOtherBCNC
NC4200064Medicaid
SC298023Medicaid
SC400649Medicaid
SC298023Medicaid
SC3387Medicare ID - Type UnspecifiedMEDICARE PART B
NC6907689Medicaid