Provider Demographics
NPI:1255446837
Name:CAROLINA'S MEDICAL ALLIANCE
Entity type:Organization
Organization Name:CAROLINA'S MEDICAL ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-776-4000
Mailing Address - Street 1:636 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-2708
Mailing Address - Country:US
Mailing Address - Phone:843-354-3572
Mailing Address - Fax:
Practice Address - Street 1:636 GREEN ST
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-2708
Practice Address - Country:US
Practice Address - Phone:843-354-3572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13816261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center