1841595667 NPI number — EDISTO REGIONAL HEALTH SERVICES 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 1841595667 NPI number — EDISTO REGIONAL HEALTH SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDISTO REGIONAL HEALTH SERVICES 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:
RMC PRIMARY CARE NORTH
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:
1841595667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1245
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGEBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29116-1245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-395-4762
Provider Business Mailing Address Fax Number:
803-536-0998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4631 SAVANNAH HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29112-8180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-247-2428
Provider Business Practice Location Address Fax Number:
803-247-2650
Provider Enumeration Date:
01/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PORTERFIELD
Authorized Official First Name:
LIZA
Authorized Official Middle Name:
Authorized Official Title or Position:
C F O
Authorized Official Telephone Number:
803-395-4458

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR1300X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 009 . This is a "BCBS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 009 . This is a "TRICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: CN8991 . This is a "RRMEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP44779 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42-3881 . This is a "RHC MEDICAID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: CK8831 . This is a "RRMEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 009 . This is a "BLUECHOICE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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