Provider Demographics
NPI:1871971457
Name:MIDDLE TYGER COMMUNITY CENTER
Entity type:Organization
Organization Name:MIDDLE TYGER COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-439-7760
Mailing Address - Street 1:84 GROCE RD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1761
Mailing Address - Country:US
Mailing Address - Phone:864-439-7760
Mailing Address - Fax:864-439-7034
Practice Address - Street 1:84 GROCE RD
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-1761
Practice Address - Country:US
Practice Address - Phone:864-439-7760
Practice Address - Fax:864-439-7034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty