Healthcare Provider Details

I. General information

NPI: 1073594313
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: 11/11/2005
Last Update Date: 02/25/2019
Certification Date:
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 100567
FLORENCE SC
29501-0567
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-4402
  • Fax: 843-777-5249
Mailing address:
  • Phone: 843-777-4402
  • Fax: 843-777-5249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL FULTON ERVIN III
Title or Position: SR VP AND CFO
Credential:
Phone: 843-777-2910