FOUR HOLES INDIAN ORGANIZATION EDISTO TRIBAL INC. (NPI# 1407250566) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407250566 |
| Entity Type | Organization |
| Organization Name | FOUR HOLES INDIAN ORGANIZATION EDISTO TRIBAL INC. |
| Other Organization Name | EDISTO INDIAN FREE CLINIC |
| Practice Address |
1125 Ridge Rd Ridgeville SC 29472-7846 |
| Practice Telephone | 8438712126 |
| Practice Fax Number | 8438326019 |
| Mailing Telephone | 8438712126 |
| Mailing Fax Number | 8438326019 |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2018-06-20 |
| Authorized Official Name | DONNIE CREEL (CHAIRMAN OF THE BOARD) |
| Authorized Official Telephone | 8438712126 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | ========= | SC | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Edisto Indian Free Clinic | Doing Business As Name - Organization |
| Street Address |
1125 RIDGE RD |
| City | RIDGEVILLE |
| State | SC |
| Zip Code | 29472-7846 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902270341 | Rebecca Pinon Dumond | Psychologist | 331 Cambell Thickett Rd, Ridgeville, SC 29472 | 2015-11-23 |
| 1649691205 | Eye C You Optical | Eyewear Supplier (Equipment, not the service) | 447 S Railroad Ave, Ridgeville, SC 29472 | 2013-12-30 |
| 1548510464 | Kd Optical | Optometrist | 447 Railroad Ave, Ridgeville, SC 29472 | 2012-09-18 |
| 1497718555 | Kimberly Dawn Stoneburner | Technician/Technologist | 447 South Railroad Ave., Ridgeville, SC 29472 | 2006-04-10 |
| 1174902332 | Nefateri Smalls | Counselor | 118 Bobby Drive, Ridgeville, SC 29472-0231 | 2015-05-21 |
| 1295067973 | Wayne R Macintosh | Psychologist | 331 Campbell Thickett Rd, Ridgeville, SC 29472-6339 | 2010-02-05 |
| 1821493024 | Sabrina Poaches | Social Worker | 331 Campbell Thickett Rd, Ridgeville, SC 29472-6339 | 2014-10-30 |
| 1922434109 | Cheryl Whitney Jefferson | Social Worker | 331 Campbell Thickett Rd, Ridgeville, SC 29472-6339 | 2013-09-19 |
| 1699011973 | Rontrella D Elliott | Social Worker | 331 Campbell Thickett Rd, Ridgeville, SC 29472-6339 | 2012-12-14 |
| 1386980662 | Deborah Vereen | Social Worker | 331 Campbell Thickett Rd, Ridgeville, SC 29472-6339 | 2012-12-14 |
| Find all providers in zip 29472 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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| Find all providers with the same taxonomy | ||||
| City | RIDGEVILLE |
| Zip Code | 29472 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.