Healthcare Provider Details

I. General information

NPI: 1689454167
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: 10/03/2023
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E CHEVES ST
FLORENCE SC
29506-2617
US

IV. Provider business mailing address

PO BOX 601743
CHARLOTTE NC
28260-1743
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL FULTON ERVIN III
Title or Position: SR. VP & CFO
Credential:
Phone: 843-777-2000