| Little River Medical Center, Inc. | |
|
4580 Highway 472 Conway SC 29526-6340 | |
| (843) 663-1013 | |
| (843) 663-1017 |
| Full Name | Little River Medical Center, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 4580 Highway 472, Conway, South Carolina |
| Authorized Official Name and Position | Avangela K 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 Little River SC 29566-7214 Ph: (843) 663-1013 | Little River Medical Center, Inc. 4580 Highway 472 Conway SC 29526-6340 Ph: (843) 663-1013 |
| NPI Number | 1770807190 |
|---|---|
| Provider Enumeration Date | 03/15/2010 |
| Last Update Date | 03/16/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770807190 | NPI | - | NPPES |
| ZA9656 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 4406 (South Carolina) | Primary |
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