Provider Demographics
NPI:1821117375
Name:TOTAL CARE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:TOTAL CARE MEDICAL CENTER LLC
Other - Org Name:TOTAL CARE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HIBBITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-648-7800
Mailing Address - Street 1:PO BOX 6295
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29804-6295
Mailing Address - Country:US
Mailing Address - Phone:803-648-7800
Mailing Address - Fax:803-648-7277
Practice Address - Street 1:190 CREPE MYRTLE DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7543
Practice Address - Country:US
Practice Address - Phone:803-648-7800
Practice Address - Fax:803-648-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC770245Medicaid
SC1221530002Medicare NSC