Provider Demographics
NPI:1841580230
Name:LAURENS COUNTY HEALTHCARE SYSTEM DBA CAROLINA WOMENS CENTER
Entity Type:Organization
Organization Name:LAURENS COUNTY HEALTHCARE SYSTEM DBA CAROLINA WOMENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AND CFO OF LCHCS
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:864-833-3976
Mailing Address - Street 1:102 MEDICAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7537
Mailing Address - Country:US
Mailing Address - Phone:864-938-0087
Mailing Address - Fax:864-938-0229
Practice Address - Street 1:102 MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7537
Practice Address - Country:US
Practice Address - Phone:864-938-0087
Practice Address - Fax:864-938-0229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAURENS COUNTY HEALTH CARE SYSTEM DBA CAROLINA WOMENS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15652207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2815Medicare UPIN