Healthcare Provider Details

I. General information

NPI: 1508094913
Provider Name (Legal Business Name): KERSHAW HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PINNACLE PARKWAY BUILDING 100
ELGIN SC
29045
US

IV. Provider business mailing address

40 PINNACLE PARKWAY BUILDING 100
ELGIN SC
29045
US

V. Phone/Fax

Practice location:
  • Phone: 803-432-4311
  • Fax:
Mailing address:
  • Phone: 803-424-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERRANCE DILLON
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 502-596-7220