Healthcare Provider Details

I. General information

NPI: 1912029612
Provider Name (Legal Business Name): TRIDENT MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 MEDICAL PLAZA DR
CHARLESTON SC
29406-9104
US

IV. Provider business mailing address

9330 MEDICAL PLAZA DR
CHARLESTON SC
29406-9104
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-7000
  • Fax: 843-797-4086
Mailing address:
  • Phone: 843-797-7000
  • Fax: 843-797-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDY S. MILLER
Title or Position: CFO
Credential:
Phone: 843-847-4100