Healthcare Provider Details

I. General information

NPI: 1245767482
Provider Name (Legal Business Name): BAPTIST EASLEY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FLEETWOOD DR
EASLEY SC
29640-2022
US

IV. Provider business mailing address

PO BOX 2089
EASLEY SC
29641-2089
US

V. Phone/Fax

Practice location:
  • Phone: 864-442-7200
  • Fax: 864-859-9362
Mailing address:
  • Phone: 864-855-5104
  • Fax: 864-859-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHLEEN M STAPLETON
Title or Position: CFO
Credential:
Phone: 864-442-8610