Provider Demographics
NPI:1215235064
Name:LORIS COMMUNITY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:LORIS COMMUNITY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LORIS PHYSICIAN CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-716-7911
Mailing Address - Street 1:3418 CASEY ST
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-2904
Mailing Address - Country:US
Mailing Address - Phone:843-716-7911
Mailing Address - Fax:843-716-7918
Practice Address - Street 1:3418 CASEY ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2904
Practice Address - Country:US
Practice Address - Phone:843-716-7911
Practice Address - Fax:843-716-7918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LORIS COMMUNITY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty