1780823294 NPI number — UNION HOSPITAL DISTRICT

Table of content: (NPI 1780823294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780823294 NPI number — UNION HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNION HOSPITAL DISTRICT
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:
1780823294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
323 W SOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNION
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29379-2838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-427-6058
Provider Business Mailing Address Fax Number:
864-427-6059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
323 W SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29379-2838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-427-6058
Provider Business Practice Location Address Fax Number:
864-427-6059
Provider Enumeration Date:
02/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PETTIT
Authorized Official First Name:
TAMI
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
864-427-9045

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP5097 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com