Healthcare Provider Details

I. General information

NPI: 1134170764
Provider Name (Legal Business Name): MEDICAL CENTER INC. OF PICKENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 POWDERSVILLE RD SUITE D
EASLEY SC
29642-3703
US

IV. Provider business mailing address

838 POWDERSVILLE RD SUITE D
EASLEY SC
29642-3703
US

V. Phone/Fax

Practice location:
  • Phone: 864-855-2323
  • Fax: 864-855-2606
Mailing address:
  • Phone: 864-855-2323
  • Fax: 864-855-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier608612
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 2
Identifier708614
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: MR. JOHN E. HOLLAND
Title or Position: PRESIDENT
Credential: PHARM D
Phone: 864-855-2323