NPIMap

Organization Active NPI

Little River Medical Center, Inc.

  • Dentist
  • Little River, SC
National Provider Identifier
1508122433
Registry record updated Apr 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
LITTLE RIVER MEDICAL CENTER, INC.
Practice address
4303 Live Oak Dr
Little River, SC 29566-9138
Phone
(843) 663-8000
Fax
(843) 663-1017
NPI assigned
Apr 4, 2012
Last updated
Apr 4, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
LITTLE RIVER MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 4, 2012

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

Authorized official

Name
Avangela K Criswell
Title
Business Office Director
Phone
(843) 663-8017

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X SC Primary
Dental Hygienist 124Q00000X SC

Addresses

Primary practice location

4303 Live Oak Dr
Little River, SC 29566-9138

Mailing address

PO Box 547
Little River, SC 29566-0547
Phone (843) 663-8000

Other identifiers 2

IdentifierTypeStateIssuer
ZA9656MedicaidSC
424024DMedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Little River Medical Ce26 organizations share this tax ID, including this one
Part of
Little River Medical Ce

Other organizations with this tax ID 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1333497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333497600000",
    "number": "1508122433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 547",
            "city": "LITTLE RIVER",
            "state": "SC",
            "postal_code": "295660547",
            "telephone_number": "843-663-8000",
            "fax_number": "843-663-1017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4303 LIVE OAK DR",
            "city": "LITTLE RIVER",
            "state": "SC",
            "postal_code": "295669138",
            "telephone_number": "843-663-8000",
            "fax_number": "843-663-1017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE RIVER MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LITTLE RIVER MEDICAL CENTER, INC.",
        "enumeration_date": "2012-04-04",
        "last_updated": "2012-04-04",
        "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": "843-663-8017"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": null,
            "primary": true
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "SC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9656",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "424024D",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little River, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2012; 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.