1497103618 NPI number — MCLEOD HEALTH CLARENDON

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 1497103618 NPI number — MCLEOD HEALTH CLARENDON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCLEOD HEALTH CLARENDON
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:
6
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:
1497103618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 E HOSPITAL ST
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
MANNING
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29102-3149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-435-5250
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 E HOSPITAL ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
MANNING
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29102-3149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-435-5250
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2016

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 VICE PRESIDENT AND CFO
Authorized Official Telephone Number:
843-777-2910

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: RHC244 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42-3459 . This is a "MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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