| Organization Name: | MIT AMBULATORY CARE CENTER |
| NPI Number: | 1043533896 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM C. PARKER (CEO) |
| Mailing Address: | 149 Riverwalk Blvd Suite 6 Ridgeland |
| State: | SC US |
| Postal Code: | 299368190 |
| Phone Number: | 9126910333 |
| Fax Number: | 9126911030 |
| NPI Enumeration Date: | 03/09/2010 |
| NPI Last Update Date: | 01/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QI0500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Infusion Therapy |
| Taxonomy Definition: | |