Healthcare Provider Details

I. General information

NPI: 1205882461
Provider Name (Legal Business Name): MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 N RAVENEL ST
FLORENCE SC
29506-2641
US

IV. Provider business mailing address

PO BOX 100567
FLORENCE SC
29501-0567
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-2800
  • Fax:
Mailing address:
  • Phone: 843-777-5802
  • Fax: 843-777-5035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL FULTON ERVIN III
Title or Position: SR. VICE PRESIDENT AND CFO
Credential:
Phone: 843-777-2910