LITTLE RIVER MEDICAL CENTER, INC. (NPI# 1619100096) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619100096 |
| Entity Type | Organization |
| Organization Name | LITTLE RIVER MEDICAL CENTER, INC. |
| Practice Address |
3817 Main St Loris SC 29569-3017 |
| Mailing Address |
Po Box 547 Little River SC 29566-0547 |
| Practice Telephone | 8436638000 |
| Practice Fax Number | 8437566828 |
| Mailing Telephone | 8436638000 |
| Mailing Fax Number | 8436631018 |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2014-12-09 |
| Authorized Official Name | MRS. PAMELA R DAVIS (CEO) |
| Authorized Official Telephone | 8436638001 |
| Authorized Official Credential | MSN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
SC | Physician Assistants & Advanced Practice Nursing Providers | |
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | FQC081 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932457751 | Little River Medical Center, Inc. | Clinic/Center | 700 Augusta Plantation Drive, Myrtle Beach, SC 29579-6713 | 2012-08-28 |
| 1225304546 | Little River Medical Center, Inc. | Counselor | 1411 10th Ave N, Myrtle Beach, SC 29577-5615 | 2012-03-30 |
| 1528333952 | Little River Medical Center, Inc. | Dentist | 504 Church St, Conway, SC 29526-4822 | 2012-03-19 |
| 1437455144 | Little River Medical Center, Inc. | Social Worker | 7726 N Kings Hwy, Myrtle Beach, SC 29572-3041 | 2011-01-28 |
| 1841514262 | Little River Medical Center, Inc. | Dentist | 3001 4th Ave, Conway, SC 29527-5914 | 2010-03-15 |
| 1679897094 | Little River Medical Center, Inc. | Dentist | 620 29th Ave N, Myrtle Beach, SC 29577-3169 | 2010-03-15 |
| 1942524368 | Little River Medical Center, Inc. | Dentist | 5209 Highway 66, Loris, SC 29569-5962 | 2010-03-15 |
| 1437473857 | Little River Medical Center, Inc. | Dentist | 1101 Snowhill Dr, Conway, SC 29526-3665 | 2010-03-15 |
| 1851615272 | Little River Medical Center, Inc. | Dentist | 3011 Nichols Hwy, Galivants Ferry, SC 29544-6059 | 2010-03-15 |
| 1770807190 | Little River Medical Center, Inc. | Dentist | 4580 Highway 472, Conway, SC 29526-6340 | 2010-03-15 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | LITTLE RIVER MEDICAL CENTER, INC. | 451 W Locke St, Ashdown, AR 71822-3325 |
| Street Address |
3817 MAIN ST |
| City | LORIS |
| State | SC |
| Zip Code | 29569-3017 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467703157 | Beverly Cecile Wilson | Nurse Practitioner | 3817 Main St, Loris, SC 29569-3017 | 2012-09-21 |
| 1326303538 | Bernice Francesca Lim | Family Medicine | 3817 Main St, Loris, SC 29569-3017 | 2012-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427464247 | Denise Logan | Dietitian, Registered | 3811 Walnut St, Loris, SC 29569 | 2014-07-02 |
| 1801231634 | Melissa Ann Miara | Internal Medicine | 3617 Casey St Ste C, Loris, SC 29569 | 2013-05-07 |
| 1356684161 | Gwyn Gordon Mcgutchen | Dentist | 3681 Spivey St., Loris, SC 29569 | 2013-03-29 |
| 1336486174 | Winferd Dale Holt | Dentist | 3980 Main Street, Loris, SC 29569 | 2013-01-14 |
| 1528314325 | Southern Living Emergency Physicians LLC | Physician Assistant | 6988 Mitchell Street, Loris, SC 29569 | 2012-07-30 |
| 1124347604 | Regina F. Holmes | Nurse Practitioner | Agape Senior Primary Care Inc Dba Main Street Physician, 3612 Mitchell Street, Loris, SC 29569 | 2010-05-24 |
| 1801914122 | Dr Gwyn Gordon Mccutchen Inc | Dentist | 3681 Spivey Street, Loris, SC 29569 | 2007-03-26 |
| 1700911203 | Twin States Helping Hands | Home Health | 1620 Hwy 701 N, Loris, SC 29569 | 2007-02-23 |
| 1306922646 | Loris Community Hospital District | Clinic/Center | 3204 Casey St, Loris, SC 29569 | 2006-10-30 |
| 1619074119 | South Carolina Cvs Pharmacy LLC | Pharmacy | 4767 Broad St, Loris, SC 29569 | 2006-09-20 |
| Find all providers in zip 29569 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1215410667 | Low Country Health Care System | Clinic/Center | 19340 Solomon Blatt Ave N, Blackville, SC 29817-2304 | 2018-09-12 |
| 1922584481 | Sandhills Medical Foundation, Inc. | Clinic/Center | 290 Market Street, Ruby, SC 29741 | 2018-07-17 |
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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.