Provider Demographics
NPI:1649507351
Name:ADVANCED WOMENS CARE OF THE LOWCOUNTRY PC
Entity type:Organization
Organization Name:ADVANCED WOMENS CARE OF THE LOWCOUNTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLUSEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-341-9700
Mailing Address - Street 1:29 PLANTATION PARK DR STE 401
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-9006
Mailing Address - Country:US
Mailing Address - Phone:843-341-9700
Mailing Address - Fax:843-706-3633
Practice Address - Street 1:29 PLANTATION PARK DR
Practice Address - Street 2:SUITE 401
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9001
Practice Address - Country:US
Practice Address - Phone:843-341-3996
Practice Address - Fax:843-706-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26583207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4904Medicaid