FOUR HOLES INDIAN ORGANIZATION EDISTO TRIBAL INC. NPI 1407250566

NPI Information

  • NPI: 1407250566
  • Provider Name: FOUR HOLES INDIAN ORGANIZATION EDISTO TRIBAL INC.
  • Classification: Clinic/Center - 261Q00000X
  • Entity Type: Organization
  • Doing Business As: EDISTO INDIAN FREE CLINIC
  • CLIA Number: 42D2129503
  • Address: 1125 RIDGE RD
    RIDGEVILLE, SC
    ZIP 29472
  • Phone: (843) 871-2126

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NPI Details

FOUR HOLES INDIAN ORGANIZATION EDISTO TRIBAL INC. is a clinic center in Ridgeville, SC. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). FOUR HOLES INDIAN ORGANIZATION EDISTO TRIBAL INC. NPI is 1407250566. The provider is registered as an organization entity type.
The provider Is Doing Business As Edisto Indian Free Clinic.

The provider's business location address is:

1125 RIDGE RD
RIDGEVILLE, SC
ZIP 29472-846
Phone: (843) 871-2126
Fax: (843) 832-6019

The provider's authorized official is Donnie Creel .
The authorized official title is Chairman Of The Board and has the following contact phone number (843) 871-2126.

The CLIA number assigned to this NPI record is 42D2129503 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/20/2014 and was last updated on 7/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/CenterSOUTH CAROLINAYes

What is NPI?

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This page was last updated on: 3/30/2025

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