Provider Demographics
NPI:1942702659
Name:MEDICAL OUTREACH CLINIC OF SUMMERVILLE INC
Entity Type:Organization
Organization Name:MEDICAL OUTREACH CLINIC OF SUMMERVILLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-771-1123
Mailing Address - Street 1:111 WARING ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-4350
Mailing Address - Country:US
Mailing Address - Phone:843-771-1123
Mailing Address - Fax:843-771-1125
Practice Address - Street 1:316 W CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-4359
Practice Address - Country:US
Practice Address - Phone:843-771-1123
Practice Address - Fax:843-771-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health