Provider Demographics
NPI:1538167598
Name:PRIMARY CARE OF HARTSVILLE
Entity type:Organization
Organization Name:PRIMARY CARE OF HARTSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:QUAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-857-0800
Mailing Address - Street 1:PO BOX 1469
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-1469
Mailing Address - Country:US
Mailing Address - Phone:843-857-0800
Mailing Address - Fax:843-857-4629
Practice Address - Street 1:701 MEDICAL PARK DR
Practice Address - Street 2:STE 104
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4777
Practice Address - Country:US
Practice Address - Phone:843-857-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty