Healthcare Provider Details

I. General information

NPI: 1679564702
Provider Name (Legal Business Name): KERSHAW HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SOUTH MAIN STREET
BETHUNE SC
29009
US

IV. Provider business mailing address

1315 ROBERTS ST
CAMDEN SC
29020-3737
US

V. Phone/Fax

Practice location:
  • Phone: 843-334-6557
  • Fax: 843-334-6583
Mailing address:
  • Phone: 803-432-4311
  • Fax: 803-713-6384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberHTL-101
License Number StateSC

VIII. Authorized Official

Name: MR. DAVIS W TURNER
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-844-9800