Provider Demographics
NPI:1720481708
Name:CLEMSON FREE CLINIC
Entity Type:Organization
Organization Name:CLEMSON FREE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MSN
Authorized Official - Phone:864-654-8277
Mailing Address - Street 1:PO BOX 941
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29633-0941
Mailing Address - Country:US
Mailing Address - Phone:864-654-8277
Mailing Address - Fax:864-654-8907
Practice Address - Street 1:1200 TIGER BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2663
Practice Address - Country:US
Practice Address - Phone:864-654-8277
Practice Address - Fax:864-654-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8228261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care