1891768842 NPI number — CHESTERFIELD MARLBORO LP

Table of content: (NPI 1891768842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891768842 NPI number — CHESTERFIELD MARLBORO LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTERFIELD MARLBORO LP
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:
CHESTERFIELD GENERAL HOSPITAL
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:
1891768842
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 198172
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-8172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 CHESTERFIELD HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHERAW
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29520-7002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-537-7881
Provider Business Practice Location Address Fax Number:
843-320-3470
Provider Enumeration Date:
02/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLTSFORD
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTH OFFICIAL / DIR BUSINESS OFFICE
Authorized Official Telephone Number:
615-465-7466

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  HTL-681 , 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: 301020 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139595 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 400621 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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