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Contact Information

EDISTO INDIAN FREE CLINIC
LBN FOUR HOLES INDIAN ORGANIZATION EDISTO TRIBAL INC.
1125 RIDGE RD
RIDGEVILLE, SC29472
 Phone: 843-871-2126
 Fax: 843-832-6019
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinic/Center

261Q00000X
Indicates primary specialty

NPI Profile & details for EDISTO INDIAN FREE CLINIC

NPI # 1407250566
LBN Legal business name FOUR HOLES INDIAN ORGANIZATION EDISTO TRIBAL INC.
DBA Doing business as EDISTO INDIAN FREE CLINIC
Authorized official DONNIE CREEL - (CHAIRMAN OF THE BOARD)
Entity Organization
Organization subpart 1 No
Enumeration date 10/20/2014
Last updated 07/21/2022 - About 4 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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