Provider Demographics
NPI:1063545119
Name:CAROLINA HEALTH CENTERS, INC.
Entity type:Organization
Organization Name:CAROLINA HEALTH CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GILMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-941-8121
Mailing Address - Street 1:219A NORTH MINE STREET
Mailing Address - Street 2:
Mailing Address - City:MCCORMICK
Mailing Address - State:SC
Mailing Address - Zip Code:29835
Mailing Address - Country:US
Mailing Address - Phone:864-852-3336
Mailing Address - Fax:864-852-3339
Practice Address - Street 1:1319 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MC CORMICK
Practice Address - State:SC
Practice Address - Zip Code:29835-7928
Practice Address - Country:US
Practice Address - Phone:864-852-3336
Practice Address - Fax:864-852-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC002Medicaid
SC=========003OtherBLUE CROSS PROVIDER ID
SC421815Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
SCFQC002Medicaid