Healthcare Provider Details

I. General information

NPI: 1447269477
Provider Name (Legal Business Name): CHARLESTON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 CALHOUN ST
CHARLESTON SC
29401-1124
US

IV. Provider business mailing address

PO BOX 931854
ATLANTA GA
31193-1854
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-2311
  • Fax:
Mailing address:
  • Phone: 843-792-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberHTL-826
License Number StateSC

VIII. Authorized Official

Name: THOMAS MOORE
Title or Position: ADMINISTRATOR
Credential:
Phone: 843-876-8302