Provider Demographics
NPI:1306979521
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 1:313 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2757
Mailing Address - Country:US
Mailing Address - Phone:864-229-4446
Mailing Address - Fax:864-229-8037
Practice Address - Street 1:313 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2757
Practice Address - Country:US
Practice Address - Phone:864-229-4446
Practice Address - Fax:864-229-8037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2024-12-18
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
SCCBP014Medicaid
SCFQC032Medicaid
SCCBP014Medicaid
SCFQC032Medicaid
SC421844Medicare Oscar/Certification
SC3621Medicare ID - Type UnspecifiedSC MEDICARE GROUP NUMBER