Provider Demographics
NPI:1740478288
Name:LOW COUNTRY ENT PA
Entity type:Organization
Organization Name:LOW COUNTRY ENT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-863-1188
Mailing Address - Street 1:2850 TRICOM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9192
Mailing Address - Country:US
Mailing Address - Phone:843-863-1188
Mailing Address - Fax:
Practice Address - Street 1:2850 TRICOM ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9192
Practice Address - Country:US
Practice Address - Phone:843-863-1188
Practice Address - Fax:843-863-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207Y00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2380Medicaid
SC1992705099OtherNPI FOR RUSSELL D. KITCH MD
SC1992705099OtherNPI FOR RUSSELL D. KITCH MD
SCGP2380Medicaid