Provider Demographics
NPI:1063381549
Name:LITTLE RIVER MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:LITTLE RIVER MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-663-8013
Mailing Address - Street 1:5605 HIGHWAY 501 E
Mailing Address - Street 2:
Mailing Address - City:AYNOR
Mailing Address - State:SC
Mailing Address - Zip Code:29511-3470
Mailing Address - Country:US
Mailing Address - Phone:843-663-8000
Mailing Address - Fax:
Practice Address - Street 1:5605 HIGHWAY 501 E
Practice Address - Street 2:
Practice Address - City:AYNOR
Practice Address - State:SC
Practice Address - Zip Code:29511-3470
Practice Address - Country:US
Practice Address - Phone:843-663-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE RIVER MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-11-03
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty