Healthcare Provider Details

I. General information

NPI: 1487701157
Provider Name (Legal Business Name): EDISTO REGIONAL HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 DORANGE RD
BRANCHVILLE SC
29432-2241
US

IV. Provider business mailing address

PO BOX 1245
ORANGEBURG SC
29116-1245
US

V. Phone/Fax

Practice location:
  • Phone: 803-274-8400
  • Fax: 803-274-8817
Mailing address:
  • Phone: 803-395-4497
  • Fax: 803-536-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHERYL S. MASON
Title or Position: C.F.O.
Credential:
Phone: 803-395-2224