1699756221 NPI number — MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.

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 1699756221 NPI number — MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.
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:
MCLEOD REGIONAL MEDICAL CENTER
Provider Other Organization Name Type Code:
5
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:
1699756221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100567
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29501-0567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-777-4402
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 E CHEVES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29506-2617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-777-4402
Provider Business Practice Location Address Fax Number:
843-777-5249
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ERVIN
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
FULTON
Authorized Official Title or Position:
SR VP AND CFO
Authorized Official Telephone Number:
843-777-2910

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  HTL-384 , 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: 000106202A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 094184100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4210301 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: MCL0051N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 334441 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4200051 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 459938 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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