1700965217 NPI number — CLARENDON MEMORIAL HOSPITAL

Table of content: (NPI 1700965217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700965217 NPI number — CLARENDON MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLARENDON MEMORIAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MANNING MEDICINE AND PALMETTO WOMEN'S HEALTHCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700965217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 E. HOSPITAL ST.
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
MANNING
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29102-3149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-435-5257
Provider Business Mailing Address Fax Number:
803-435-5259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 E. HOSPITAL ST.
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
MANNING
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29102-3149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-435-5257
Provider Business Practice Location Address Fax Number:
803-435-5259
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NETTLES
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR/DIVISION MANAGER COMMUNITY
Authorized Official Telephone Number:
803-435-5270

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RHC 532 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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