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NPI Code Detail

MEDICARE: ROBERT S. EAGERTON, JR. M.D.,LLC

MEDICARE: ROBERT S. EAGERTON, JR. M.D.,LLC
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
1261QR1300XRural Health Clinic/Center11415SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RHC1700093705OTHERSCRHC RIVERBEND
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700093705
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT S. EAGERTON, JR. M.D.,LLC
Provider Business Mailing Address
First Line : 200 E HOSPITAL ST
Second Line :
City : MANNING
State : SC
Zip : 29102-3160
Country : US
Telephone Number : 803-433-0439
Fax Number : 803-433-9840
Provider Business Practice Location Address
First Line : 200 E HOSPITAL ST
Second Line :
City : MANNING
State : SC
Zip : 29102-3160
Country : US
Telephone Number : 803-433-0439
Fax Number : 803-433-9840
Authorized Official
Title or Position : OWNER
Name : DR. ROBERT S EAGERTON JR.
Credential : M.D.
Telephone Number : 803-433-0439
Provider Enumeration Date : 05/17/2007
Last Update Date : 03/31/2009

Similar Medicare Providers

1558366039 — DR. ROBERT S EAGERTON JR. M.D.
Practice Location Address:
200 E HOSPITAL ST
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29102-3160
Practice Phone: 803-433-0439
Practice Fax: 803-433-9840
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1336413681 — CLARENDON MEMORIAL HOSPITAL
Practice Location Address:
200 E HOSPITAL ST
MANNING, SC
29102-3160
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Practice Fax: 803-433-9840
1962851097 — MCLEOD HEALTH CLARENDON
Practice Location Address:
200 E HOSPITAL ST
MANNING, SC
29102-3160
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Practice Fax:
1659722411 — DR. CARMEN CRIBB ROBERTS D.O.
Practice Location Address:
200 E HOSPITAL ST
MANNING, SC
29102-3160
Practice Phone: 803-433-0439
Practice Fax: 803-433-9840

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