NPIMap

Organization Active NPI

Live Oak Medical Center, PA

  • Rural Health Clinic/Center
  • Kingstree, SC
National Provider Identifier
1285869222
Registry record updated Jun 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
9352 Issued in SC
Legal business name
LIVE OAK MEDICAL CENTER, PA
Practice address
342 W Main St
Kingstree, SC 29556-3235
Phone
(843) 687-0435
NPI assigned
May 20, 2009
Organization subpart
Yes
Parent organization
LIVE OAK MEDICAL CENTER, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 4, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Albert Durant Mims, M.D.
Title
Director
Phone
(843) 687-0435

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 9352 SC Primary

Addresses

Primary practice location

342 W Main St
Kingstree, SC 29556-3235

Mailing address

342 W Main St
Kingstree, SC 29556-3235
Phone (843) 687-0435

National Provider Directory

National Provider Directory
Tax ID family
Live Oak Medical Center PA3 organizations share this tax ID, including this one
Part of
Live Oak Medical Center PA

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

342 W Main St
Kingstree, SC 29556
Phone (843) 355-2434

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244073600000",
    "number": "1285869222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 W MAIN ST",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295563235",
            "telephone_number": "843-687-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 W MAIN ST",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295563235",
            "telephone_number": "843-687-0435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE OAK MEDICAL CENTER, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIVE OAK MEDICAL CENTER, PA",
        "enumeration_date": "2009-05-20",
        "last_updated": "2009-06-04",
        "status": "A",
        "authorized_official_last_name": "MIMS",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "DURANT",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "843-687-0435",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SC",
            "license": "9352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingstree, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.