MEDICARE: MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	HPF003	SC
2	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043289333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.

Provider Business Mailing Address
First Line	:	1203 EAST CHEVES STREET
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29506-2711
Country	:	US
Telephone Number	:	843-777-2564
Fax Number	:	843-777-5135

Provider Business Practice Location Address
First Line	:	1203 EAST CHEVES STREET
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29506-2711
Country	:	US
Telephone Number	:	843-777-2564
Fax Number	:	843-777-5135

Authorized Official
Title or Position	:	SR. VICE PRESIDENT AND CFO
Name	:	MR. SAMUEL FULTON ERVIN III
Credential	:
Telephone Number	:	843-777-2910

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	05/03/2016

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