Active NPI
Little River Medical Center, Inc.
- Dentist
- Loris, SC
National Provider Identifier
1225218605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Legal business name
- LITTLE RIVER MEDICAL CENTER, INC.
- Practice address
- 2801 Red Bluff Rd
Loris, SC 29569-6224 - Phone
- (843) 756-5136
- Fax
- (843) 756-3965
- NPI assigned
- Nov 14, 2007
- Last updated
- Apr 27, 2010
- Organization subpart
- Yes
- Parent organization
- LITTLE RIVER MEDICAL CENTER, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Avangela K Criswell
- Title
- Business Office Director
- Phone
- (843) 663-1013
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | NU | Primary |
Addresses
Primary practice location
2801 Red Bluff Rd
Loris, SC 29569-6224
Mailing address
287 Highway 90 E Ste 5
Ste#5
Little River, SC 29566-7214
Phone (843) 663-1013
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZA9656 | Medicaid | SC |
National Provider Directory
National Provider Directory- Part of
- Little River Medical Center
Locations
2801 Red Bluff Rd
Loris, SC 29569
Phone (843) 756-5136
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194998400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1272326400000",
"number": "1225218605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "287 HIGHWAY 90 E STE 5",
"address_2": "STE#5",
"city": "LITTLE RIVER",
"state": "SC",
"postal_code": "295667214",
"telephone_number": "843-663-1013",
"fax_number": "843-663-1017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2801 RED BLUFF RD",
"city": "LORIS",
"state": "SC",
"postal_code": "295696224",
"telephone_number": "843-756-5136",
"fax_number": "843-756-3965"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LITTLE RIVER MEDICAL CENTER, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "LITTLE RIVER MEDICAL CENTER, INC.",
"enumeration_date": "2007-11-14",
"last_updated": "2010-04-27",
"status": "A",
"authorized_official_last_name": "CRISWELL",
"authorized_official_first_name": "AVANGELA",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
"authorized_official_telephone_number": "843-663-1013",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZA9656",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Loris, SC
- Leigh M Kressler, CRNP
- Christian Lara-Ensslin, PA-C
- Bernice Francesca Lim, MD
- Little River Medical Center Inc (Little River Medical Center Pharmacy)
- Little River Medical Center, Inc.
- Little River Medical Center, Inc.
- Little River Medical Center, Inc.
- Alexander C Logan III, MD
- Denise Logan, MS RD LD
- John C Lohlun, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.