| NPI | 1184195158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATONYA D SANDERS-MILLER Phleboto MIS T 843-957-8782 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 251E00000X Home Health |
| 251S00000X Community/Behavioral Health | |
| 261QC1500X Clinic/Center Community Health | |
| 302F00000X Exclusive Provider Organization | |
| 305S00000X Point of Service | |
| 335V00000X Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2022-01-18 |