Healthcare Provider Details

I. General information

NPI: 1649818253
Provider Name (Legal Business Name): MCLEOD HEALTH CHERAW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CHESTERFIELD HWY
CHERAW SC
29520-7001
US

IV. Provider business mailing address

555 E CHEVES ST
FLORENCE SC
29506-2617
US

V. Phone/Fax

Practice location:
  • Phone: 843-537-2171
  • Fax:
Mailing address:
  • Phone: 843-777-5562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL FULTON ERVIN III
Title or Position: SENIOR VP AND CFO
Credential:
Phone: 843-777-2910