Healthcare Provider Details

I. General information

NPI: 1467825166
Provider Name (Legal Business Name): ABBEVILLE COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date: 06/02/2020
Reactivation Date: 08/25/2020

III. Provider practice location address

6 COLLEGE ST
DUE WEST SC
29639-9554
US

IV. Provider business mailing address

PO BOX 887
ABBEVILLE SC
29620-0887
US

V. Phone/Fax

Practice location:
  • Phone: 864-379-2345
  • Fax: 864-379-3228
Mailing address:
  • Phone: 864-366-3279
  • Fax: 864-366-3317

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: MATTHEW TOLBERT LOGAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 864-725-4780