Provider Demographics
NPI:1841428125
Name:LORIS PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:LORIS PHYSICIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-716-7194
Mailing Address - Street 1:3655 MITCHELL STREET
Mailing Address - Street 2:BOX 690001
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-9601
Mailing Address - Country:US
Mailing Address - Phone:843-716-7194
Mailing Address - Fax:843-716-7195
Practice Address - Street 1:3655 MITCHELL STREET
Practice Address - Street 2:BOX 690001
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-9601
Practice Address - Country:US
Practice Address - Phone:843-716-7194
Practice Address - Fax:843-716-7195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LORIS COMMUNITY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty