1699756221 NPI number — MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.

Table of content: (NPI 1689844557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699756221 NPI number — MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.
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:
1699756221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100567
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29501-0567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-777-4402
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 E CHEVES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29506-2617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-777-4402
Provider Business Practice Location Address Fax Number:
843-777-5249
Provider Enumeration Date:
11/10/2005

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 VP AND CFO
Authorized Official Telephone Number:
843-777-2910

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  HTL-384 , 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: 000106202A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 094184100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4210301 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: MCL0051N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 334441 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4200051 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 459938 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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