Provider Demographics
NPI:1972971117
Name:COMMUNITY MEDICAL CLINIC OF KERSHAW COUNTY
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL CLINIC OF KERSHAW COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:CHCQM
Authorized Official - Phone:803-713-0806
Mailing Address - Street 1:110 E DEKALB ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4432
Mailing Address - Country:US
Mailing Address - Phone:803-713-0806
Mailing Address - Fax:803-713-0526
Practice Address - Street 1:110 E DEKALB ST
Practice Address - Street 2:SUITE C
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4432
Practice Address - Country:US
Practice Address - Phone:803-713-0806
Practice Address - Fax:803-713-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14008261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health