1962704056 NPI number — CLARENDON MEMORIAL HOSPITAL

Table of content: (NPI 1962704056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962704056 NPI number — CLARENDON MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLARENDON MEMORIAL HOSPITAL
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:
PALMETTO WOMEN'S HEALTHCARE
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:
1962704056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 E HOSPITAL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANNING
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29102-3152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-433-0797
Provider Business Mailing Address Fax Number:
803-433-0896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 E HOSPITAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANNING
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29102-3152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-433-0797
Provider Business Practice Location Address Fax Number:
803-433-0896
Provider Enumeration Date:
11/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
NETTLES
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
803-435-5270

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: GP5575 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com