Provider Demographics
NPI:1316449333
Name:LOWER FLORENCE COUNTY HOSPTIAL
Entity type:Organization
Organization Name:LOWER FLORENCE COUNTY HOSPTIAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:STUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-374-2036
Mailing Address - Street 1:PO BOX 1479
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-1479
Mailing Address - Country:US
Mailing Address - Phone:843-374-2036
Mailing Address - Fax:843-374-5675
Practice Address - Street 1:324 MERCY ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2332
Practice Address - Country:US
Practice Address - Phone:843-374-9945
Practice Address - Fax:843-374-5699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE CITY COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC084553Medicaid