Healthcare Provider Details

I. General information

NPI: 1417110032
Provider Name (Legal Business Name): EDGEFIELD COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 RIDGE MEDICAL PLAZA SUITE B
EGEFIELD SC
29824-4535
US

IV. Provider business mailing address

155 RIDGE MEDICAL PLAZA SUITE B
EDGEFIELD SC
29824-4535
US

V. Phone/Fax

Practice location:
  • Phone: 803-637-3630
  • Fax: 803-637-5348
Mailing address:
  • Phone: 803-637-3630
  • Fax: 803-637-5348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberHTL479
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberHTL479
License Number StateSC

VIII. Authorized Official

Name: MRS. JENNIFER W JOHNSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 803-637-3630