Carolina Medical Center of Walterboro PA
Organization Active NPI Specialist · Walterboro, SC
NPI 1306042585 · NPPES record last updated Jun 7, 2023
Key facts
- NPI
- 1306042585
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- CAROLINA MEDICAL CENTER OF WALTERBORO PA
- Practice address
- 461 Spruce St
Walterboro, SC 29488-2766 - Phone
- (843) 549-4335
- NPI assigned
- Jun 25, 2007
- Organization subpart
- No
Authorized official
- Name
- Tanya Hill
- Title
- Office Manager
- Phone
- (843) 549-4335
Practitioners 2
-
Sanjay Kumar, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D0878134 | Carolina Medical Center | Certificate of waiver | Jul 15, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050825000816 | SC | Part B Supplier - Clinic/Group Practice | 3779514112 |
Receives reassigned benefits from 2 practitioners Practice locations: Walterboro, SC |
National Provider Directory
Locations
461 Spruce St
Walterboro, SC 29488
Phone (843) 549-4335
302 Ruby St
Walterboro, SC 29488
Phone (843) 549-6743
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | SC | Yes |
Addresses
Primary practice location
461 Spruce St
Walterboro, SC 29488-2766
Mailing address
461 Spruce St
Walterboro, SC 29488-2766
Phone (843) 549-4335
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275632309 | Other | SC | DR. KUMAR'S NPI |
| 19591 | Other | SC | DR.B'S STATE LICENSE # |
| 195915 | Medicaid | SC | |
| 621156 | Other | SC | DR.K'S FIRST CHOICE # |
| H016147061 | Other | SC | DR.B'S RAIL ROAD MC# |
| 452043939 | Other | SC | DR.B'S BC# |
| 452043939 | Other | SC | DR.B'S SS# |
| 487949774 | Other | SC | DR.K'S SS# |
| 164379 | Medicaid | SC | |
| 110222814 | Other | SC | DR.KUMAR'SRAIL ROAD MC # |
| 16437 | Other | SC | DR.K'S STATE LICENSE # |
| 20018291 | Other | SC | DR.B'S FIRST CHOICE # |
Other providers in Walterboro, SC
- David Campbell
- Cannady Agency Inc.
- Trent Edward Cannon
- Capital Care Resources of South Carolina, LLC
- Carolina Eyecare Physicians, LLC
- Carolina Orthotics and Prosthetics LLC
- Carolina Speech Pathology Services LLC
- Allison Glover Carr
- Anne Garrett Carter
- Brittany Michelle Gruber Carter
All providers in Walterboro, SC · Specialist in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.