Provider Demographics
NPI:1144458167
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: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:919-880-6406
Mailing Address - Street 1:3980 HIGHWAY 9 E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-7832
Mailing Address - Country:US
Mailing Address - Phone:843-390-8320
Mailing Address - Fax:843-390-8329
Practice Address - Street 1:3980 HIGHWAY 9 E
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7832
Practice Address - Country:US
Practice Address - Phone:843-390-8320
Practice Address - Fax:843-390-8329
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LORIS COMMUNITY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-29
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty