| Little River Medical Center, Inc. | |
|
5000 Tulip Grove Rd Green Sea SC 29545-4977 | |
| (843) 392-1078 | |
| (843) 392-1090 |
| Full Name | Little River Medical Center, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 5000 Tulip Grove Rd, Green Sea, South Carolina |
| Authorized Official Name and Position | Avangela Kay Criswell (BUSINESS OFFICE DIRECTOR) |
| Authorized Official Contact | 8436631013 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Little River Medical Center, Inc. 287 Highway 90 E Ste 5 Ste#5 Little River SC 29566-7214 Ph: (843) 663-1017 | Little River Medical Center, Inc. 5000 Tulip Grove Rd Green Sea SC 29545-4977 Ph: (843) 392-1078 |
| NPI Number | 1619158938 |
|---|---|
| Provider Enumeration Date | 11/15/2007 |
| Last Update Date | 05/26/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619158938 | NPI | - | NPPES |
| ZA9656 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |