Provider Demographics
NPI:1871757385
Name:CAROLINA RURAL PRACTICE MANAGEMENT, INC.
Entity type:Organization
Organization Name:CAROLINA RURAL PRACTICE MANAGEMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:CLIFTON
Authorized Official - Last Name:ALSBROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-641-6277
Mailing Address - Street 1:22 GARDNER RD
Mailing Address - Street 2:P. O. BOX 247
Mailing Address - City:BLACKVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29817-3126
Mailing Address - Country:US
Mailing Address - Phone:803-641-6277
Mailing Address - Fax:
Practice Address - Street 1:22 GARDNER RD
Practice Address - Street 2:
Practice Address - City:BLACKVILLE
Practice Address - State:SC
Practice Address - Zip Code:29817-3126
Practice Address - Country:US
Practice Address - Phone:803-641-6277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0847Medicaid