Provider Demographics
NPI:1922468826
Name:LOW COUNTRY HEALTH CARE SYSTEM, INC
Entity Type:Organization
Organization Name:LOW COUNTRY HEALTH CARE SYSTEM, INC
Other - Org Name:WILLISTON FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-632-2533
Mailing Address - Street 1:86 WREN ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1529
Mailing Address - Country:US
Mailing Address - Phone:803-259-5762
Mailing Address - Fax:803-259-3250
Practice Address - Street 1:13649 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:SC
Practice Address - Zip Code:29853-5835
Practice Address - Country:US
Practice Address - Phone:803-266-0060
Practice Address - Fax:803-266-0065
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOW COUNTRY HEALTH CARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-04
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC#198Medicaid
SC6850Medicare PIN
SC421040Medicare Oscar/Certification