1487758041 NPI number — MARION REGIONAL HEALTHCARE SYSTEM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487758041 NPI number — MARION REGIONAL HEALTHCARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARION REGIONAL HEALTHCARE SYSTEM
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:
MARION MEDICAL CENTER OB/GYN
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:
1487758041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2845 E HIGHWAY 76
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
MULLINS
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29574-6037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-431-2740
Provider Business Mailing Address Fax Number:
843-431-2197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2845 E HIGHWAY 76
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
MULLINS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29574-6037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-431-2740
Provider Business Practice Location Address Fax Number:
843-431-2197
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TUCKER
Authorized Official First Name:
HAROLD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
843-431-2405

Provider Taxonomy Codes

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

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

  • Identifier: 296147 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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