1063449361 NPI number — ABBEVILLE COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1063449361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063449361 NPI number — ABBEVILLE COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABBEVILLE COUNTY 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:
ABBEVILLE AREA MEDICAL CENTER
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:
1063449361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 887
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABBEVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29620-0887
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-336-3279
Provider Business Mailing Address Fax Number:
864-366-3317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 THOMSON CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABBEVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-366-5011
Provider Business Practice Location Address Fax Number:
864-366-3317
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
MARY
Authorized Official Middle Name:
MARGARET
Authorized Official Title or Position:
CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
864-366-3279

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  HTL-098 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: DPE053 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9089888 00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0098SB , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 142571 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252726 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 400612 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00104607A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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