Provider Demographics
NPI:1013986017
Name:LOWCOUNTRY LUNG & CRITICAL CARE PA
Entity Type:Organization
Organization Name:LOWCOUNTRY LUNG & CRITICAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-572-3514
Mailing Address - Street 1:9150 MEDCOM ST
Mailing Address - Street 2:STE B
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9196
Mailing Address - Country:US
Mailing Address - Phone:843-572-3330
Mailing Address - Fax:843-572-1255
Practice Address - Street 1:9150 MEDCOM ST
Practice Address - Street 2:STE B
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9196
Practice Address - Country:US
Practice Address - Phone:843-572-3330
Practice Address - Fax:843-572-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherTAX