MEDICARE: EDISTO REGIONAL MEDICAL CENTER

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	207Q00000X	Family Medicine Physician

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	:	1639117732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDISTO REGIONAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 1442
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29116-1442
Country	:	US
Telephone Number	:	803-395-4499
Fax Number	:	803-395-4480

Provider Business Practice Location Address
First Line	:	1727 VILLAGE PARK DR
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-2475
Country	:	US
Telephone Number	:	803-531-2722
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS DANDRIDGE
Credential	:
Telephone Number	:	803-395-2200

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	08/22/2020

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Directions to “EDISTO REGIONAL MEDICAL CENTER ” Practice Location

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