1982800397 NPI number — PELHAM MEDICAL CENTER

Table of content: (NPI 1982800397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982800397 NPI number — PELHAM MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PELHAM MEDICAL CENTER
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:
Provider Other Organization Name Type Code:
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:
1982800397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 198886
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:
30384-8886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-560-4123
Provider Business Mailing Address Fax Number:
864-560-4023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 WESTMORELAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29651-9013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-530-6000
Provider Business Practice Location Address Fax Number:
864-530-4665
Provider Enumeration Date:
06/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MEINKE
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
864-560-6103

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  HTL-0905 , 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: B00905 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 795944823A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A00905 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4200103 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: GP4916 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".