Provider Demographics
NPI:1114743176
Name:LOW COUNTRY HEALTH CARE SYSTEM MOBILE HEALTH SERVICES
Entity type:Organization
Organization Name:LOW COUNTRY HEALTH CARE SYSTEM MOBILE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-632-2533
Mailing Address - Street 1:130 BAKER ST N
Mailing Address - Street 2:
Mailing Address - City:BLACKVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29817-2426
Mailing Address - Country:US
Mailing Address - Phone:803-284-1045
Mailing Address - Fax:
Practice Address - Street 1:130 BAKER ST N
Practice Address - Street 2:
Practice Address - City:BLACKVILLE
Practice Address - State:SC
Practice Address - Zip Code:29817-2426
Practice Address - Country:US
Practice Address - Phone:803-284-1045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOW COUNTRY HEALTH CARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)