| Organization Name: | LIVE OAK MEDICAL CENTER, PA |
| NPI Number: | 1285869222 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALBERT DURANT MIMS (DIRECTOR) |
| Mailing Address: | 342 W Main St Kingstree |
| State: | SC US |
| Postal Code: | 295563235 |
| Phone Number: | 8436870435 |
| Fax Number: | |
| NPI Enumeration Date: | 05/20/2009 |
| NPI Last Update Date: | 06/04/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 9352 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |