1487656294 NPI number — REGENCY HOSPITAL COMPANY OF SOUTH CAROLINA, LLC

Table of content: (NPI 1487656294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487656294 NPI number — REGENCY HOSPITAL COMPANY OF SOUTH CAROLINA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENCY HOSPITAL COMPANY OF SOUTH CAROLINA, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1487656294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4714 GETTYSBURG RD
Provider Second Line Business Mailing Address:
LEGAL DEPT
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17055-4325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-972-1100
Provider Business Mailing Address Fax Number:
717-975-9981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 E CEDAR ST
Provider Second Line Business Practice Location Address:
4TH AND 5TH FLOOR
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-661-3499
Provider Business Practice Location Address Fax Number:
843-661-3401
Provider Enumeration Date:
08/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TARVIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
717-972-1100

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  HTL-824 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11067A , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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