Provider Demographics
NPI:1962442244
Name:LOW COUNTRY HEALTH CARE SYSTEM, INC
Entity Type:Organization
Organization Name:LOW COUNTRY HEALTH CARE SYSTEM, INC
Other - Org Name:BARNWELL PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARAINEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:JR
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 1:10706 MARLBORO AVENUE
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1529
Practice Address - Country:US
Practice Address - Phone:803-259-7337
Practice Address - Fax:803-259-9505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOW COUNTRY HEALTH CARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QF0400X, 261QF0400X
SC10503208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC174Medicaid
SCFQC174Medicaid
SCRHC004Medicaid
SCFZC174Medicaid
SCRHC004Medicaid
SC421043Medicare Oscar/Certification
SCH19657Medicare UPIN
SCF864Medicare PIN