| Low Country Health Care System, Inc | |
|
333 Revolutionary Trail Farifax SC 29827 | |
| (803) 632-2533 | |
| (803) 632-1537 |
| Full Name | Low Country Health Care System, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 333 Revolutionary Trail, Farifax, South Carolina |
| Authorized Official Name and Position | Megan Anderson (PHARMACIST) |
| Authorized Official Contact | 8036322533 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Low Country Health Care System, Inc Po Box 990 Fairfax SC 29827 Ph: (803) 632-2533 | Low Country Health Care System, Inc 333 Revolutionary Trail Farifax SC 29827 Ph: (803) 632-2533 |
| NPI Number | 1053475566 |
|---|---|
| Provider Enumeration Date | 12/20/2006 |
| Last Update Date | 11/15/2023 |
| Medicare PECOS PAC ID | 4284530940 |
|---|---|
| Medicare Enrollment ID | O20031211000944 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053475566 | NPI | - | NPPES |
| 751105 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | William M Yates |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1740361906 PECOS PAC ID: 6002709755 Enrollment ID: I20040205000792 |
| Provider Name | Teresa A Williams |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1417977190 PECOS PAC ID: 0547234825 Enrollment ID: I20040823000915 |
| Provider Name | Rossie Reid |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205840733 PECOS PAC ID: 8628009719 Enrollment ID: I20050829000621 |
| Provider Name | Richard Elmer Boyles |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003820531 PECOS PAC ID: 7618900523 Enrollment ID: I20050912001155 |
| Provider Name | Bryan Tolliver |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972684199 PECOS PAC ID: 8022183367 Enrollment ID: I20080820000599 |
| Provider Name | Gloria J Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962463521 PECOS PAC ID: 5496899874 Enrollment ID: I20100223000658 |
| Provider Name | Lucille Sanders |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538170121 PECOS PAC ID: 4981734639 Enrollment ID: I20100608000046 |
| Provider Name | Ronald D Padgett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942206362 PECOS PAC ID: 9638221781 Enrollment ID: I20100909000594 |
| Provider Name | Janet Marie Mckissick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407878366 PECOS PAC ID: 5496938508 Enrollment ID: I20110328000610 |
| Provider Name | John V Custer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578679452 PECOS PAC ID: 3476727140 Enrollment ID: I20111114000872 |
| Provider Name | Courtney Sandifer Drawdy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801166277 PECOS PAC ID: 7618136995 Enrollment ID: I20120306000291 |
| Provider Name | Abraham H Moskow |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1730221292 PECOS PAC ID: 7810179009 Enrollment ID: I20121128000134 |
| Provider Name | Meredith C Hipp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679826820 PECOS PAC ID: 3375796865 Enrollment ID: I20130111000416 |
| Provider Name | James Robert Mynatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588815021 PECOS PAC ID: 2961640123 Enrollment ID: I20130529000534 |
| Provider Name | Baxter F Mclendon |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1033160254 PECOS PAC ID: 8022264274 Enrollment ID: I20131109000398 |
| Provider Name | Saranne S Oneal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336300748 PECOS PAC ID: 8628208691 Enrollment ID: I20140313001543 |
| Provider Name | Bryan Allan Burnett |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1376685453 PECOS PAC ID: 5496937682 Enrollment ID: I20140710000638 |
| Provider Name | Marsha Wren Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093143836 PECOS PAC ID: 1951527233 Enrollment ID: I20140722001853 |
| Provider Name | Vishal Abiraj |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356652283 PECOS PAC ID: 8820239783 Enrollment ID: I20140814000873 |
| Provider Name | Mari S Bridges |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740543164 PECOS PAC ID: 3375780927 Enrollment ID: I20160614000651 |
| Provider Name | Christopher S Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205389335 PECOS PAC ID: 8426346412 Enrollment ID: I20161006001040 |
| Provider Name | Wanda W Tutt |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1851656243 PECOS PAC ID: 4789972233 Enrollment ID: I20161017000304 |
| Provider Name | Kimberly Dawn Spires |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194278879 PECOS PAC ID: 0547558918 Enrollment ID: I20161018001733 |
| Provider Name | Edward Chaum |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1023075868 PECOS PAC ID: 6406898493 Enrollment ID: I20161212000784 |
| Provider Name | Jennifer Denise Rahn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689094666 PECOS PAC ID: 8820319619 Enrollment ID: I20170905002673 |
| Provider Name | Vernon C Whitley |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1295818987 PECOS PAC ID: 8628051281 Enrollment ID: I20180806000878 |
| Provider Name | Heather R Nolan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902307598 PECOS PAC ID: 2860728839 Enrollment ID: I20190729002915 |
| Provider Name | Anthony Mcpherson |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1477537660 PECOS PAC ID: 1052361722 Enrollment ID: I20190731004228 |
| Provider Name | Kristen M Caulder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780220921 PECOS PAC ID: 5496181372 Enrollment ID: I20200213000302 |
| Provider Name | Chinise Kayanna Clinton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023635935 PECOS PAC ID: 2860811064 Enrollment ID: I20201007000381 |
| Provider Name | Lauren Ashley Ray-villalobos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942834528 PECOS PAC ID: 5991115909 Enrollment ID: I20201103001386 |
| Provider Name | Amy Ellis Kinard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720603202 PECOS PAC ID: 7315357332 Enrollment ID: I20201103001537 |
| Provider Name | Tracy Stichert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063032316 PECOS PAC ID: 2062818321 Enrollment ID: I20210913000165 |
| Provider Name | Alexis K Strang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386313062 PECOS PAC ID: 0244622298 Enrollment ID: I20220125000388 |
| Provider Name | Erica L O'quinn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033860671 PECOS PAC ID: 7012302433 Enrollment ID: I20220322002836 |
| Provider Name | Ashley Roxanne Peterson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346700796 PECOS PAC ID: 9234511395 Enrollment ID: I20220805001379 |
| Provider Name | Elizabeth Sandifer |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1730550963 PECOS PAC ID: 9133420623 Enrollment ID: I20221116000457 |
| Provider Name | Lisa Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710608377 PECOS PAC ID: 1557739620 Enrollment ID: I20221121001734 |
| Provider Name | Colton Tyler Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982263323 PECOS PAC ID: 6800121021 Enrollment ID: I20221213001785 |
| Provider Name | Elizabeth Harrison Shuler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275243461 PECOS PAC ID: 3274724315 Enrollment ID: I20230531000914 |
| Provider Name | Vicki Lynn Landis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194067066 PECOS PAC ID: 1557597515 Enrollment ID: I20230629001194 |
| Provider Name | Walter Schmalstieg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740209683 PECOS PAC ID: 7618016262 Enrollment ID: I20230727000991 |
| Provider Name | Vanessa Simmons |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396149340 PECOS PAC ID: 7911359427 Enrollment ID: I20240120000405 |
| Provider Name | Troy Spires |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881459162 PECOS PAC ID: 2961923230 Enrollment ID: I20250304001524 |
| Provider Name | Caitlin Sullivan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700607868 PECOS PAC ID: 0244751436 Enrollment ID: I20250304002514 |